Ingles Med Apostila 2024

Inglês Médico
Aluno(a): _______________________________________________________________________ .
PROGRAMAÇÃO: Início: 18:30 / Textos são trabalhados p/: tradução, interpretação e versão
2024-1 Término: 20:10 ao português
Dia/ ATIVIDA TEMA NATUREZA

Mês DE
15/2 - FERIADO -
22/2 REUNIÃO Apresentação do método e do curso, e fornecimento do Expositiva E
material didático. Explicativa
29/2 Não Recesso: semana de provas de monitoria -
7/3 1ª AULA Tradução, interpretação e versão ao português: temas gerais. Tarefas em grupo
14/3 2ª AULA Tradução, interpretação e versão ao português: Anatomia Tarefas em grupo
Humana
Clínica e Cirúrgica-I
28/3 Não FERIADO -
Clínica e Cirúrgica-II
11/4 PR1 Tarefas de sala com o professor: valendo a Nota Prova para todos
18/4 5ª AULA Tradução, interpretação e versão ao português: Descrição de Tarefas em grupo
cirurgia
25/4 6ª AULA Tradução, interpretação e versão ao português: Biologia Tarefas em grupo
Molecular
2/5 7ª AULA Tradução, interpretação e versão ao português: Tecnologia Tarefas em grupo
biomédica
9/5 8ª AULA Tradução, interpretação e versão ao português: Farmacologia Tarefas em grupo
16/5 9ª AULA Tradução, interpretação e versão ao português: Fisiologia Tarefas em grupo
23/5 10ª AULA Tradução, interpretação e versão ao português: Semiologia Tarefas em grupo
Médica
30/5 Não FERIADO -
6/6 PR2 Tarefas de sala com o professor: valendo a Nota Prova para todos
13/ 2ª Tarefas de sala com o professor valendo a Nota Prova
CHAMAD
AS
20/6 PR3 Tarefas de sala com o professor valendo a Nota Prova
27/6 FECHAMENTO DE PAUTA ELETRÔNICA DO SEMESTRE
(*) Não há tarefas de casa, todas são feitas durante as aulas. Cuidado com o limite de faltas p/ não reprovar
“por faltas”. 20 semanas letivas = 20 aulas = apenas 20% de faltas permitidas = 4 faltas em aulas, no máximo.
1
1º TEMA: assuntos gerais
ATENÇÃO: Seu trabalho de sala deve ser entregue individualmente, identificado e escrito à caneta
OU lápis em uma folha pautada diferente deste material de apoio.
Tarefa 1
TEXTO A TRABALHAR:
“My boyfriend was out of town when my cat had surgery. He sent my cat a get well soon card. Goofy,
but I didn’t know people that nice existed.” (Fonte do parágrafo – rede social da internet: postasecret.com em 2012)
a) Escreva a “tradução simples” (texto traduzido palavra por palavra ou expressão por expressão)
do texto acima. (Transcrevendo o apresentado no Google Tradutor) = no seu rascunho apenas.
b) Agora, note as inconsistências da tradução dada. E dê a sua (melhor) versão para o texto (expressões
coloquiais brasileiras atuais), mas sem alterar o conteúdo. Faça este trabalho em uma folha de
rascunho e depois transcreva para a Folha Definitiva com seu Nome (que deve ser entregue ao fim
da atividade em sala). = à limpo na sua folha de tarefas presenciais.
Tarefa 2
(ATENÇÃO: ANOTE O SEU TEMPO CONSUMIDO PARA REALIZAR ESTA TAREFA e busque aprimorar seu
instrument de trabalho: conexão à internet, editor de texto, espaço de trabalho, grupo de colegas, etc. )
Fonte: https://www.med.wisc.edu (em 2012)

TEXTO A TRABALHAR:
The University of Wisconsin: School of Medicine and Public Health.
Parágrafo I: The mission of the University of Wisconsin School of Medicine and Public Health
(SMPH) is to meet the health needs of Wisconsin and beyond through excellence in education,
research, patient care and service.
Parágrafo II: The school is working to bring together unprecedented resources that will help create
transforming research initiatives and an entirely new model of medical education—one that balances
traditional learning with a focus on population health; that strives to seamlessly translate research
successes to compassionate care.
Parágrafo III: With a superb faculty, talented students, enthused leadership and exciting new
facilities such as the Health Sciences Learning Center (HSLC) and the Wisconsin Institutes for
2
Medical Research (WIMR), the school is ready to create a visionary approach to both health and health
care into the next century.
Parágrafo IV: WIMR is the home to world-renowned researchers from many disciplines. This
collaborative environment provides astounding opportunities for these researchers to determine
solutions to society’s most complex health problems.
Parágrafo V: Funding Priorities: Private gifts make a tremendous difference in helping the
University of Wisconsin School of Medicine and Public Health accomplish its mission: to meet the
health needs of Wisconsin and beyond through excellence in education, research, patient care and
service.
Trabalha-se um parágrafo por vez (em sala):

a) Primeiro: usando o Google Tradutor On Line: obtenha a “tradução simples” (texto traduzido
integralmente, ou palavra por palavra, ou expressão por expressão), um parágrafo por vez. Este é
um texto de natureza “administrativa” e “publicitária” ao mesmo tempo. Transcreva o apresentado
pelo Google Tradutor na sua folha de rascunhos.
b) Em seguida, note/grife as inconsistências da tradução dada.
Raciocine conforme seu vocabulário e gramática pessoais.
E por fim: dê a sua (melhor) versão para o texto, mas sem alterar o conteúdo. Faça este
trabalho em uma folha de rascunho e depois transcreva para a Folha Definitiva com seu Nome (que
deve ser entregue ao fim da atividade em sala).
Trabalharemos UM parágrafo por vez, debatendo.
Tarefa 3
TEXTO A TRABALHAR:
Dean’s Fund for Excellence Make a gift »
Traditional funding sources cover only the school’s most basic operating costs. Your gift to the School
of Medicine and Public Health’s Dean’s Fund provides dollars that can be used to attract the best
students and faculty. These funds give the school the flexibility to respond to unexpected opportunities.
They are used for faculty support, scholarship aid, technology, seed funding for new programs,
translational research and outreach programs.
Wisconsin Institutes for Medical Research Building Fund Make a gift »
With open laboratories on floors nearly the length of a football field, shared equipment and connected
social spaces, the towers of the Wisconsin Institutes for Medical Research are designed for synergy. As
researchers and physician scientists come together in one spot and share ideas, their perspectives
shift, a spark ignites. Discoveries are made. This is where the UW School of Medicine and Public
Health scientists and clinicians will collaborate to discover new treatments to improve the quality of
patients’ lives and find cures for diseases that have been incurable.
School of Medicine and Public Health Scholarship Fund Make a gift »
Your gift helps build an endowment that provides annual scholarships for medical students. The
Medical School Honors and Awards Committee establishes qualifications for recipients. In a time
when our medical students typically graduate with more than $100,000 in debt, your contribution
makes a significant difference.
Tarefa 3 / Responda objetivamente, extraindo “em inglês” a resposta do texto acima. E dê

sua melhor versão ao português.
a) Qual fundo financeiro fornece bolsas para estudantes? = responda na sua folha de exercícios.
3
b) Quem escolhe os alunos que receberão bolsa? = responda na sua folha de exercícios.
Tarefa 4
Fonte: uptodate.com (em 2012)
Wound healing and risk factors for non-healing
Authors: David G. Armstrong, DPM, MD, PhD Andrew J Meyr, DPM Last literature review version 19.2:
May 2011 | This topic last updated: Junho 16, 2011.
A wound is a disruption of the normal structure and function of the skin and underlying soft
tissue [1]. Acute wounds in normal, healthy individuals heal through an orderly sequence of
physiological events that include hemostasis, inflammation, epithelialization, fibroplasia, and
maturation [2]. When this process is altered or stalled, a chronic wound may develop and is more
likely to occur in patients with underlying disorders such as peripheral artery disease, diabetes, venous
insufficiency, nutritional deficiencies, and other disease states. Chronic ulceration commonly affects
the lower extremities with a prevalence that ranges between 0.18 and 1.3 percent in the adult
population [2-5].
Wound healing occurs as a cellular response to tissue injury and involves activation of
keratinocytes, fibroblasts, endothelial cells, macrophages, and platelets. The process involves
organized cell migration and recruitment of endothelial cells for angiogenesis. Many growth factors
and cytokines released by these cell types coordinate and maintain wound healing. Once hemostasis is
achieved, acute wounds normally heal in an orderly and efficient manner characterized by overlapping
phases that include inflammation, epithelialization, fibroplasia, and maturation [3-5].
Acute wounds transition through the stages of wound healing as a linear pathway, with clear
start- and endpoints. Chronic wounds are arrested in one of these stages, usually the inflammatory
stage, and cannot progress further. In these situations, the normal physiology of the linear pathway is
transformed into the pathophysiology of a chronic cycle, without a clear wound closure endpoint.
References:
1. Orr JW, Taylor PT. Wound healing. In: Complications in gynecological surgery: Prevention, recognition, and management, JB Lippincott, Philadelphia
p.167.
2. Lipscomb GH, Ling, FG. Wound Healing, Suture Material, and Surgical Instrumentation. In: TeLinde's Operative Gynecology, 9th edition, Rock, JA,
Jones, HA, III (Eds), 2003. p.233.
3. Diegelmann RF, Evans MC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci 2004; 9:283.
4. Leibovich SJ, Ross R. The role of the macrophage in wound repair. A study with hydrocortisone and antimacrophage serum. Am J Pathol 1975; 78:71.
5. Mor-Vaknin N, Punturieri A, Sitwala K, Markovitz DM. Vimentin is secreted by activated macrophages. Nat Cell Biol 2003; 5:59.
Tarefa 4 / Responda objetivamente em português (a partir do texto acima):

a) Quantas são as fases da Cicatrização?
b) A coagulação sanguínea faz parte dos eventos/fases da cicatrização? Se sim: qual a sua
posição/lugar dentre elas?
c) A ferida crônica fica “paralisada” em qual fase?
2º TEMA: anatomia médica

(preferentemente) em uma folha pautada diferente deste material de apoio.
Tarefa 1
4
FONTE: internet (site de apoio estudantil omitido / 2012)
Human anatomy can be precisely defined as a complementary basic medical science, which
deals with the scientific study of morphology of human body. In simpler words, human anatomy is the
study of structure of human body.
There are two main levels of structure of human body (as well as every other thing):
macroscopic level and microscopic level. For each of the two levels, there is a separate subdivision of
anatomy. The one dealing with macroscopic level is known as gross anatomy and the other which
deals with microscopic level is called microscopic anatomy or histology.
Tarefa 1) O texto acima possui redundâncias. Gere uma versão em português: resumida mas
sem excluir informações objetivas: duas até quatro linhas – a partir de todo o texto acima
Tarefa 2
Introduction to Muscular System:
Muscular system is the system of Human Body that provides motor power for all movements of
body parts. Muscular system is composed of special tissue called muscular tissue. Muscles have the
ability to contract actively to provide the force for movements of body parts. Muscles produce not only
those movements that are under the control of our will and that we can see and feel, but also those
movements that are responsible for activities like breathing, digestion of food, pumping of blood, etc..
Types of muscles:
Skeletal Muscles:
Skeletal muscles form most of the human body weight. They are under the control of human
will and all body movements occurring by our will are produced by skeletal muscles. They are called
skeletal muscles because they are almost always found attached to the skeleton and produce
movements in different parts of the skeleton.
Smooth Muscles:
Smooth muscles form the soft body organs like stomach, intestine, blood vessels, etc.. They are
not under the will of human beings and are responsible for unconscious body activities like digestion
of food. They are called smooth muscles because when seen under the microscope, they do not have
any striation in contrast to the other two types of muscles.
Cardiac Muscles:
Cardiac muscles are exclusively found in human heart and no where else. They are extremely
strong and powerful muscles. They are not under the control of human will and are involuntary. The
pumping of blood by human heart is because of the force provided by the contraction of cardiac
muscles.
2a) What kind of muscles are not under the human voluntary control?
2b) A redação científica prima pela simplicidade e facilidade de compreensão, ao mesmo tempo
que, pela objetividade e precisão das informações. A expressão latina et cetera (etc.) é uma
expressão usada para exprimir quantidade imprecisa; por exemplo: e outros (and others), e diversos
outros (and many others), e outros mais (and other else) são formas mais claras de expressar a idéia
de pluralidade, mas pode transmitir ao leitor uma idéia de imprecisão ou ignorância sobre o que
constitui esse plural (ou essa totalidade).
Para evitar essa “falha” de redação, reconstrua o parágrafo a seguir suprimindo a expressão “ etc.”
da maneira mais clara e objetiva que você conseguir (sem alterar ou retirar informação do texto)
Traduza e transcreva na sua folha de rascunho este texto:“Muscles produce not only those
movements that are under the control of our will and that we can see and feel, but also those
movements that are responsible for activities like breathing, digestion of food, pumping of blood,
etc..”
5
Dê a sua versão abolindo o “etc” deste texto = responda na sua folha de exercícios.
Tarefa 3
Fonte: Regions and Planes of the Abdomen. Janz BA, Gest TR. Medscape Reference. Lippincott Williams & Wilkins Royalty
REGIONS AND PLANES OF THE ABDOMEN
Overview
The anatomy of the regions and planes of the abdomen is composed of many layers with
varying blood supply and innervation. The abdomen has been bisected, trisected, and even divided into
as many as 9 separate regions. The layers of the abdominal wall consist of the skin, superficial fascia,
and muscles.
Abdominal planes
The anatomic planes of the abdominal wall are made up of skin, multiple muscular and fascial
layers that interdigitate and unite to form a sturdy, protective musculofascial layer that protects the
visceral organs and provides strength and stability to the body's trunk. This anatomy varies with
respect to the different topographic regions of the abdomen; thus, a firm understanding of these layers,
their blood supply, and their innervation is essential to surgical management of the abdomen.
The abdominal cavity is the largest hollow space in the body. It is bound cranially by the
xiphoid process of the sternum and the costal cartilages of ribs 7-10; caudally, by the anterior ilium
and the pubic bone of the pelvis; anteriorly, by the abdominal wall musculature; and posteriorly, by the
L1-L5 vertebrae.
Abdominal regions
The abdominal wall has few anatomic landmarks. The flat abdominal plane is broken up only
by the costal margins, anterior superior iliac spines, and the umbilicus. Thus, many attempts have been
made over the years to describe what surface anatomy cannot.
The most common and widely accepted system for identification of the various regions of the
abdomen is the simple division of the abdomen into four quadrants by a vertical and horizontal line
bisecting the umbilicus and forming the right and left upper and lower quadrants.[1]
Tarefa 3:
a) “Navel e "belly button" são sinônimos para? Cite em português.
Analise as afirmações abaixo e compare com as informações contidas no texto acima.
Julgue verdadeiras (V) ou falsas (F). Cite os fragmentos do texto (em inglês) que você usou
para fundamentar seu julgamento:
b) Abdomen can be divided in 9 planes.
c) A divisão do abdome em, simplesmente, quatro quadrantes é pouco recomendada devido a
sua imprecisão.
d) O umbigo é o ponto anatômico de referência central (de junção) dos quadrantes abdominais.
Tarefa 4
Superficial Fascia
The superficial fascia of the abdominal wall is the layer encountered just deep to the skin. It
consists of connective tissue that contains a variable amount of fat. This layer can vary in thickness
from less than 1 cm to greater than 15 cm, depending on a person's body habitus.
Tarefa 4: Analise as afirmações abaixo e compare com as informações contidas no texto acima. Julgue
verdadeiras (V) ou falsas (F). Cite o fragmento do texto (em inglês) que você usou para fundamentar seu
julgamento:
6
a) A camada de fáscia abdominal superficial situa-se abaixo da pele e do tecido adiposo
(gordura).
Camper and Scarpa fasciae

Superior to the umbilicus, the superficial fascia consists of a single layer. Inferior to the
umbilicus, it splits into 2 layers. The more superficial and fatty layer is the Camper fascia. The deeper,
more fibrous layer is the Scarpa fascia. The Scarpa fascia contains very little fat and is continuous with
both the superficial fascia of the thigh known as the fascia lata and the superficial fascia of the
perineum known as the Colles fascia.
julgamento:
b) Inferiormente à cicatriz umbilical, a camada adiposa (gordurosa) mais profunda é também a
mais espessa. = responda na sua folha de exercícios.
c) A fáscia abdominal mais profunda (de Scarpa) continua-se no períneo, onde apenas troca de
nome para fáscia superficial perineal (de Colles). = responda na sua folha de exercícios.
The fasciae are displayed in the image below.
Tarefa 5
Muscles of the Abdominal Wall

The abdominal wall is composed of 5 paired muscles: 2 vertical muscles (the rectus abdominis
and the pyramidalis) and 3 layered, flat muscles (the external abdominal oblique, the internal
abdominal oblique, and the transversus abdominis muscles). These muscles and their fascial
attachments interdigitate and unite to form a sturdy, protective musculofascial layer that gives strength
and support to the anterolateral abdominal wall (see the images below).
Layers of the abdominal wall:
7
External abdominal oblique muscle
The external abdominal oblique muscle is the largest and most superficial of the 3 paired, flat
abdominal muscles. It arises from the lower 8 ribs and interdigitations of the serratus anterior muscle.
As the external abdominal oblique courses in an inferior medial direction, its muscle fibers change
from thick muscle to a fibrous aponeurosis that inserts medially in the linea alba. Inferiorly, the
external abdominal oblique aponeurosis folds back on itself to form the inguinal ligament between the
anterior superior iliac spine and the pubic tubercle before inserting onto the pubic tubercle and the
anterior half of the iliac crest. Just medial to its insertion on the pubic tubercle, the aponeurosis divides
and forms the superficial (or external) inguinal ring.
The external abdominal oblique is innervated in a segmental pattern by the anterior rami of the
inferior 6 thoracoabdominal nerves (T7-T12).
Internal abdominal oblique muscle
The internal abdominal oblique muscle is the intermediate layer of the 3 paired, flat abdominal
muscles. It originates broadly from the anterior portion of the iliac crest, lateral half of the inguinal
ligament, and thoracolumbar fascia. The internal abdominal oblique inserts on the inferior border of
the 10th-12th ribs, the linea alba, and the pubic crest via the conjoint tendon. The muscle fibers of the
internal abdominal oblique course upward in a superomedial orientation, perpendicular to the muscle
fibers of the external abdominal oblique.
Like the external abdominal oblique, the internal abdominal oblique forms a broad aponeurosis
that fuses into the midline and contributes to the rectus sheath. Superior to the arcuate line (see the
image below), the internal abdominal oblique aponeurosis splits anteriorly and posteriorly to enclose
the rectus muscle and helps form the rectus sheath. However, inferior to the arcuate line, the internal
abdominal oblique aponeurosis does not split and only passes anterior to the rectus muscle as part of
the anterior rectus sheath.
Muscles of the abdominal wall & the arcuate line.

a. = artery; Ant. = anterior; Ext. = exterior; Inf. = inferior; Int. = interior; m. = muscle; Post. = posterior; v = vein.
8
The inferior aponeurotic fibers of the internal abdominal oblique muscle course over the
spermatic cord, through the inguinal canal, and the medial fibers fuse with the aponeurosis of the
transversus abdominis muscle to form the conjoint tendon.
The internal oblique is innervated in a segmental pattern by the anterior rami of the inferior 6
thoracoabdominal nerves (T7-T12) and first lumbar nerves (iliohypogastric and ilioinguinal nerves).
Of note, all the neurovascular structures supplying the abdominal muscles run in the plane
between the internal abdominal oblique muscle and the transversus abdominis muscle, except for the
iliohypogastric and ilioinguinal nerves. Initially, they lie on the anterior surface of the quadratus
lumborum, then pass laterally into the plane between the transversus abdominis and the internal
abdominal oblique. Above the anterior superior iliac spine, they penetrate the internal abdominal
oblique to run between this muscle and the aponeurosis of the external abdominal oblique muscle.
julgamento:
a) Qual o sentido de orientação das fibras do Músculo Oblíquo Abdominal Interno?
b) Onde estão localizados os nervos e vasos sanguíneos que suprem a musculatura abdominal?
Transversus abdominis muscle

The transversus abdominis muscle is the deepest of the 3 paired, flat abdominal muscles. It
originates on the internal surfaces of the 7th–12th costal cartilages, thoracolumbar fascia, anterior three
fourths of the iliac crest, and lateral third of the inguinal ligament.
As with the other flat muscles, the transversus abdominis forms a broad aponeurosis that helps
make up the rectus sheath before it fuses in the midline to the linea alba. Above the arcuate line, the
transversus abdominis aponeurosis contributes to the posterior rectus sheath. Below the arcuate line, it
is fused with the other flat muscles as the anterior rectus sheath. (See image above.)
As its name implies, the muscle and aponeurotic fibers run in a transverse direction, except for
the inferior most aponeurotic fibers. These fibers curve in an inferomedial direction to unite with the
aponeurosis of internal abdominal oblique to form the conjoint tendon, which attaches onto the pubic
crest and the pectineal (Cooper) ligament. The inferior aponeurotic fibers are fused to the underlying
transversalis fascia, thus forming the posterior wall of the inguinal canal. A small triangular opening in
this posterior wall is known as the deep or internal inguinal ring. It is at this opening that the spermatic
9
cord is formed (by the ductus deferens, testicular vessels, and genital branch of genitofemoral nerve)
and through which all indirect inguinal hernias develop.
The transversus abdominis is innervated in a segmental pattern by the anterior rami of the
inferior 6 thoracoabdominal nerves (T7-T12) and first lumbar nerves (iliohypogastric and ilioinguinal
nerves).
julgamento:
b) O Ligamento do Cooper une as fibras inferiors do músculo transverso abdominal ao
tubérculo púbico, na crista púbica.
c) Os músculos abdominais: Transverso, Oblíquo Interno e Oblíquo Externo compartilham
idêntica inervação.
Rectus abdominis muscles

The rectus abdominis muscles are paired, long muscles that run just lateral to the linea alba in a
vertical direction from the xiphoid process of the sternum and costal cartilage of the 5th-7th ribs to the
pubic symphysis. These muscles function to tense the abdominal wall, flex the trunk, stabilize the
pelvis, and aid in childbirth, defecation, micturition, and forced expiration.
Each muscle is divided along its course by 3 or 4 transverse fibrous bands known as tendinous
intersections, which essentially divide the muscle into a series of interconnected muscles. This results
in one's "abs" or "six-pack." The rectus muscles are contained within the rectus sheath, which is
formed by the aponeuroses of the external abdominal oblique, internal abdominal oblique, and
transversus abdominis muscles.
The rectus muscle is innervated in a segmental pattern by the anterior rami of the T7-T12
thoracoabdominal nerves.
Abdominal wall vasculature.
The rectus muscles have a dual blood supply. The superior epigastric artery and vein, which are
direct continuations of the internal thoracic vessels, supply the superior half of the rectus muscles. The
inferior epigastric artery and vein, which arise from the external iliac vessels just proximal to their
passage under the inguinal ligament, supply the inferior portion of the rectus muscles and run
superiorly until they anastomose with the superior epigastric vessels. In addition, there are numerous
small, segmental contributions from the lower 6 intercostal vessels (see the image below).
Tarefa 5: De acordo com o texto (imediatamente) acima; responda:
10
d) Quais são as artérias (e ramos) que suprem o Músculo Reto Abdominal?
Traduza o texto acima e leia-o atentamente, dê resposta discursive elaborada no seu rascunho, julgue debatendo com colegas e o
professor antes de finalizar.
Pyramidalis muscle
The pyramidalis muscle is a small, triangular muscle that lies anterior to the inferior aspect of
the rectus abdominis muscles. It originates at the pubic symphysis and attaches superiorly at the linea
alba. This muscle functions to tense the linea alba and aid in midline stabilization. The pyramidalis
muscle is generally considered insignificant in humans and is, in fact, absent in about 20% of the
population.
Tarefa 5: Responda:
e) O Músculo Piramidal está descrito no parágrafo anterior. Cite, em português, a sua Origem, Inserção e
Ação(ões).
FONTES: Autores Medscape usaram (2012) as seguintes fontes: 1. Moore KL, Agur AM, Dalley AF. Essential Clinical Anatomy. 4th ed. Philadelphia, Pa:
Lippincott Williams & Wilkins; 2011:116-35. 2. Gray H. Anterior abdominal wall. In: Standring S, ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 39th ed.
Philadelphia, Pa: Elsevier Churchill Livingstone; 2005:1104-11. 3. Grevious, MA, Cohen M, White AD, Wihelmi BJ. Abdominal wall reconstruction. Medscape Reference
[serial online]. July 18, 2008;Accessed February 26, 2011. Available at http://emedicine.medscape.com/article/1297226-overview. 4. Skandalakis PN, Skandalakis JE,
Colburn GL, Kingsnorth AN, Weidman TA, Skandalakis LJ. Chapter 9: Abdominal wall and hernias. In: Skandalakis JE, ed. Skandalakis' Surgical Anatomy: The Embryologic
and Anatomic Basis of Modern Surgery. Athens, Greece: Paschalidis Medical Publications; 2004:[Full Text]. 5. Townsend C, Beauchamp DR, Evers MB, Mattox KL, eds.
Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:837-72. 6. Rosse C, Gaddum-Rosse P, eds. Abdomen. Hollinshead's Textbook of
Anatomy. 5th ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1997:518-25, 622-8.

3º TEMA: anatomia clínica e cirúrgica
Tarefa 1
Fontes: *emedicine.medscape.com - Author: Steven L Lee, MD; Chief Editor: John Geibel, MD, DSc, MA * Ruedi TP.
Apendicite. Cap. 103. Apêndice. In Manual de clínica cirúrgica: cirurgia geral e especialidades – editor Júlio Cezar Uili Coelho. – São
Paulo : Ed. Atheneu, 2009. * Melton GB, Duncan MD. Acute appendicitis. Management of appendicitis. Open surgical approach.
Section IV: Large Bowel. In: Current surgical therapy. – editor John L. Cameron. – Philadelphia : Ed. Mosby Elsevier, 2008. * Scott-
Conner CEH, Dawson DL. Traduzido de 2a Ed. de Operative anatomy Anatomia Operatória. Cap. 68. Apendicectomia e Ressecção de
Divertículo Ileal. – São Paulo : Ed. Roca, 2006.
ABOUT THE RIGHT INFERIOR ABDOMINAL QUADRANT – VERMIFORM APPENDIX

RELEVANT ANATOMY
Embryologically, the appendix is a continuation of the cecum and is first delineated during the
fifth month of gestation. The appendix does not elongate as rapidly as the rest of the colon, thus
forming a wormlike structure.[1]
The appendix averages 10 cm in length but can range from 2-20 cm. The wall of the appendix
consists of 2 layers of muscle, an inner circular and outer longitudinal. The longitudinal layer is a
continuation of the taeniae coli. The appendix is lined by colonic epithelium. [1]
Few submucosal lymphoid follicles are noted at birth. These follicles enlarge, peak from 12-20
years, and then decrease. This correlates with the incidence of appendicitis.
Blood supply to the appendix is mainly from the appendicular artery, a branch of the ileocolic
artery. This artery courses through the mesoappendix posterior to the terminal ileum. An accessory
appendicular artery can branch from the posterior cecal artery. This artery can lead to significant
intraoperative and postoperative hemorrhage and should be searched for carefully and ligated once the
main appendicular artery is controlled. [2]
11
The base of the appendix is fairly constant and is located at the posteromedial wall of the
cecum about 2.5 cm below the ileocecal valve. This is also where the taeniae converge.[2]
The base is at a constant location, whereas the position of the tip of the appendix varies. In 65%
of patients, the tip is located in a retrocecal position; in 30%, it is located at the brim or in the true
pelvis; and, in 5%, it is extraperitoneal, situated behind the cecum, ascending colon, or distal ileum.
The location of the tip of the appendix determines early signs and symptoms.
References: 1. Condon RE, Telford GL. Appendicitis. In: Townsend CM, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern
Surgical Practice. 14th ed. Philadelphia, Pa: WB Saunders and Co; 1991:884-898. 2. Liu CD, McFadden DW. Acute abdomen and appendix. In:
Greenfield LJ, Mulholland MW, eds. Surgery: Scientific Principles and Practice. 2nd ed. Baltimore, Md: Williams & Wilkins; 1997:1246-1261.
Tarefa 1:
1a) Explique brevemente (em uma a três linhas, e em português) como ocorre a origem
(embriologica) do apêndice (cecal) vermiforme.
1b) Que fenômeno histológico ocorre no apêndice, entre os 12 e 20anos de idade, que é
considerada uma possível causa de apendicite? Responda em português (uma frase).
Analise as afirmações abaixo e compare com as informações contidas no texto acima. Julgue verdadeiras (V) ou falsas (F) e
cite o fragmento do texto (em inglês) que você usou para fundamentar seu julgamento:
1c) A base do apendice (no ceco) é variável, possui localizações diferentes possíveis.
ACUTE APPENDICITIS:
Inflammation of the appendix, including subsequent clinical sequelae of abscess and
perforation, was first described in 1886 by Reginald Fitz. Today acute appendicitis is the most
common surgical emergency of the abdomen, with more than 250,000 appendectomies performed
annually in the United States.
Although the diagnosis of appendicitis in a young man with acute abdominal pain localized to
the right lower quadrant can be clear-cut, the clinical diagnosis may be less straightforward in women
of childbearing age and at the extremes of age. In these patients, appendicitis can still be a challenging
clinical entity to diagnose in a timely, accurate, and cost-effective manner. Important considerations
for surgeons and areas of debate include investigative radiology tests such as computed tomography
(CT) and ultrasonography and the use of laparoscopy as a diagnostic and therapeutic approach.
As with other etiologies of the acute abdomen, early, accurate recognition of patients requiring
urgent operative repair should be the overriding principle in the workup and treatment of patients with
suspected appendicitis. Delayed diagnosis in the treatment of acute appendicitis is associated with
higher rates of perforation, with resultant increased morbidity and mortality.
Tarefa 1:
Analise as afirmações abaixo e compare com as informações contidas no texto acima. Julgue verdadeiras (V)
ou falsas (F). Cite o fragmento do texto (em inglês) que você usou para fundamentar seu julgamento:
1d) Acute appendicitis does not allow delay in operative repair as other causes of acute
abdomen.
1e) Inaccuracy to confirm the diagnosis of acute appendicitis, resulting in delayed diagnosis and
treatment, increases the patients’ morbidity and mortality.
1f) Investigative radiology tests in acute appendicitis include laparoscopy.
1g) Computed tomography, ultrasonography and the laparoscopy shorten the time of the acute
appendicitis diagnosis.
1h) Ultrasonography is always able to differ acute appendicites from other etiologies of the
acute abdomen.
Parte 2
PRESENTATION OF ILNESS
12
The location, timing, and character of pain and associated symptoms are key factors to elicit in
understanding the presentation of disease. The classic presentation is an individual with cramping,
intermittent abdominal pain, usually beginning in the periumbilical or epigastric region and that
subsequently migrates to the right lower quadrant.
As the course of appendicitis progresses, pain progresses from intermittent and cramping to
constant and sharp in nature. If the appendix does not lie in an anterior or pelvic position, the diagnosis
of appendicitis may be more difficult, leading to potential delay. In particular, a retrocecal appendix
may not cause local signs of peritonitis.
The timing of nausea can also help to distinguish appendicitis, in which nausea follows the
pain, from gastroenteritis, in which nausea typically precedes pain. Most patients present with
anorexia.
A low-grade fever is often present in uncomplicated appendicitis. High fevers are atypical for
simple appendicitis and may be a sign of perforation, appendiceal abscess, or another disease process.
Other clinical entities to be considered in the differential diagnosis include urinary tract
infection, renal calculi, gastroenteritis, gynecologic diagnoses such as ruptured ovarian cyst or pelvic
inflammatory disease, cholecystitis, diverticulitis, or small bowel obstruction.
Tarefa 2: Responda objetivamente (baseado apenas nas informações do texto acima) em português:
2a) Qual o aspecto/comportamento da “febre” na apendicite aguda?
2b) Qual a posição da ponta do apêndice que pode sequer gerar peritonite?
2c) Cite 5 diagnósticos diferenciais de apendicite aguda na mulher.
Parte 3
PATHOPHYSIOLOGY OF APPENDICITIS
The exact pathophysiology of acute appendicitis is not entirely clear, but the prevailing theory
is that appendiceal luminal obstruction is the key mechanism. In children, lymphoid hyperplasia, often
in the setting of infection or dehydration, is thought to be the most common etiology of obstruction. In
the adult population, fecaliths, as well as rare scarring or tumor, are the main causes of obstruction
leading to acute appendicitis.
Obstruction causes distention of the lumen of the appendix, yielding increased intramural and
intraluminal pressures. This leads to lymphatic and vascular compromise with ischemia and then
necrosis of the appendix with associated bacterial overgrowth.
In the first 24 hours, the great majority of patients have inflammation and possibly necrosis,
with perforation uncommon. Approximately two thirds of patients with perforated appendicitis have
had symptoms for more than 48 hours. Early in appendicitis, the most common bacteria are aerobic
organisms. In contrast, late appendicitis is associated with mixed infections.
Common organisms associated with late appendicitis are Escherichia coli, Streptococcus
species, Proteus, Bacteroides fragilis, and Pseudomonas species.
APENDICITE: ETIOLOGIA E PATOGÊNESE

A obstrução do lúmen do apêndice é o fator iniciante principal da apendicite aguda na grande
maioria dos casos. As causas mais frequentes de obstrução são hiperplasia do tecido linfóide
apendicular, fecalitos (fezes endurecidas), corpos estranhos (sementes, fibras vegetais, bário),
vermes e neoplasias. A hiperplasia do tecido linfóide é a causa mais comum nas crianças e os
fecalitos no adulto.
Com a obstrução do lúmen do apêndice e a manutenção da secreção de muco pela mucosa
apendicular, ocorrem distensão do apêndice e aumento da pressão intraluminar, a qual ocasiona
obstrução linfática e venosa, edema e ulcerações da mucosa. A proliferação das bactérias residentes
no apêndice (flora colônica) é secundária. Esse estágio é denominado de “apendicite aguda catarral”.
13
Quando o processo inflamatório e a proliferação bacteriana estendem-se até a serosa, ocorre
“apendicite aguda supurativa”.
Com o aumento mais acentuado da pressão intraluminar, ocorre trombose venosa, e quando
esta ultrapassa a pressão arteriolar observam-se isquemia e gangrena do apêndice, estágio
chamado de “apendicite aguda gangrenosa”.
A presença de necrose tecidual associada à hipertensão intraluminar ocasiona perfuração do
apêndice e extravasamento de pus que é geralmente bloqueado pelo epíplon e tecidos vizinhos
(95%) e forma um abscesso periapendicular. A perfuração pode ocasionalmente ser para peritônio
livre (5%), principalmente em crianças abaixo de dois anos e idosos acima de 65 anos. Nos casos de
perfuração não bloqueada, o acúmulo de pus ocorre preferentemente na região pélvica e espaço
sub-hepático direito. Esse estágio é denominado de “apendicite aguda perfurativa”.
Tarefa 3:
Este exercício simula um estudo autônomo do aluno com dois livros diferentes, mas sobre o mesmo assunto (etiopatogenia da
apendicite aguda). Muitos professores não gostam de apresentar, em suas aulas, as informações dos textos acima de maneira
cursiva nos seus slides; eles apresentam frases resumidas citando cada informação bem objetivamente. Assim, também deve
proceder o aluno em Seminários e Apresentações ancoradas em Power Point / slides.
3) Após ler e grifar as informações (conhecimento) objetivas nos textos acima: Construa
uma Tabela Vertical enumerando informações “objetivas” do texto em português e outra
Tabela Vertical para as informações do texto em inglês. Há informações no texto em inglês que repetem as
do texto em português, para essas, basta citar o número. Use uma página com layout horizontal para caber ambas as Listas.
Parte 4
DIAGNOSIS, HISTORY AND PHYSICAL EXAM
Initial features in the history are typically nonspecific, including indigestion, change in bowel
habits, and malaise. Following this, patients most typically experience visceral-type pain in the
periumbilical or sometimes epigastric region that is characteristically intermittent, poorly localized,
and often not terribly severe. Nausea and vomiting, which can occur, usually follow the onset of pain.
Similarly, fever may be present and usually occurs following the onset of pain. The presence of high
fever (>39.4°C) may be a sign of a perforated appendix. Early stages of appendicitis may not elicit
tenderness on physical examination.
Signs of localized inflammation or peritonitis occur as the disease progresses. Patients with an
appendix in the anterior position typically have tenderness in the right lower quadrant near McBurney's
point (two thirds of the distance from the umbilicus to the anterior superior iliac crest), often
associated with peritoneal signs. In contrast, patients with a retrocecal appendix often have less
impressive tenderness. Tenderness in patients with a pelvic appendix is often below McBurney's point.
These patients often have symptoms of dysuria, urinary frequency, diarrhea, or tenesmus. Several
classical maneuvers on physical examination have been described to aid in the diagnosis of
appendicitis (Table 1).
Table 1 – Maneuvers on Physical Examination in Patients with Suspected Appendicitis.
MANEUVER DESCRIPTION
Rovsing’s Palpation of the left lower quadrant eliciting pain in the
sign right lower quadrant
Obturator sign Pain with internal rotation of the hip (pelvic appendix)
Extension of the right hip eliciting pain in the right hip
Iliopsoas sign
(retrocecal appendix)
Tarefa 4:
a) Dor abdominal aguda localizada na fossa ilíaca direita (no ponto de McBurney) é um
dos sinais sugestivos de apendicite aguda. Responda (em português) qual a característica
14
anatômica específica do apêndice que é responsável por esse sinal.
b) Que evento evoca a Febre Alta (e a partir de quantos graus Celsius)?
c) Após ler o texto acima, complete a frase: O SINAL DE ROVSIG (POSITIVO) É.....
Parte 5
MANAGEMENT OF APPENDICITIS – OPEN SURGICAL APPROACH
The traditional open surgical approach involves an incision approximately 4 cm long centered
over McBurney's point, lateral to the rectus sheath. It cannot be overemphasized that by staying lateral
to the rectus sheath, anatomic clarity is easily achieved. This incision can be oblique along skin folds
or transverse, which is more easily extended for increased exposure. The dissection is carried through
the subcutaneous tissues to the external oblique fascia, which is then sharply incised. The muscle-
splitting technique is then used to bluntly separate the external oblique fibers, followed by the internal
oblique and transversus abdominis muscle fibers. The peritoneum is carefully entered.
This layer-by-layer anatomic exercise is one of the joys of general surgery.
On entry to the peritoneal cavity, turbid or murky fluid may be encountered; we do not
advocate culture of peritoneal fluid because the results so rarely affect clinical management. To locate
the appendix, a finger is swept lateral to medial in the right paracolic gutter. If the appendix is not
found with this maneuver, the teniae coli can be followed to the base of the cecum, where the appendix
originates.
After it is located, adhesions can be freed from the appendix (and any surrounding structures),
and it can be delivered through the incision with care to avoid tearing and possible spilling enteric
contents. The mesoappendix is divided between Rienhoff clamps and tied off using 3–0 suture. The
appendix is then ligated at its base with 2–0 absorbable suture, clamped distal to this, and sharply
excised. The appendiceal stump is cauterized to prevent mucocele formation. If the appendiceal stump
appears weak or necrotic, a purse-string suture or Z-stitch may be placed in the cecum to invert the
base into the cecum. The surgical bed should be thoroughly irrigated with saline.
Tarefa 5:
a) Segundo o autor do texto: a dissecção “plano a plano” é uma das maiores “alegrias” do
cirurgião. Cite, em português, todos os planos (ou camadas) tegumentares que o cirurgião
incisa e-ou divulsiona para acessar o apêndice (pela via clássica de McBurney).
b) Descreva em suas palavras (português) como o cirurgião procede para “localizar e prender
entre os dedos” o apêndice dentro da cavidade abdominal.
APENDICECTOMIA – PONTOS TÉCNICOS

A causa mais comum de apendicite aguda é a obsbrução do lúmen apendicular por um fecalito.
Nesses casos, o apêndice distal ao fecalito se torna inflamado e edematoso; entretanto, a porção
proximal ao fecalito permanece relativamente normal. Dessa forma, a dissecção do apêndice passando
a porção inflamada em direção ao ceco muitas vezes prodz um segmento do apêndice que pode ser
ligado com segurança (Figura abaixo – passo A). Disseque com cautela o apendice para baixo da sua
origem cecal. Comprima o apêndice cuidadosamente com um clampe e, em seguida, clampeie
exatamente distal à porção comprimida. Ligue o apêndice através da porção previamente comprimida,
clampeie acima da ligadura e corte na base do apêndice (Figura abaixo – passo B).
Se desejar, inverta o coto apendicular, usando uma “sutura em bolsa de tabaco” ou pontos em
“Z” (Figura abaixo – passo C e D). A sutura invertida deverá ser colocada em largura suficiente para
permitir ao ceco cobrir o coto completamente, quando a sutura é amarrada; entretanto, ela não deverá
envolver a válvula ileocecal ou a artéria apendicular. Como existe mobilidade lateral máxima, a sutura
pode ser colocada mais larga lateralmente, permitindo ao ceco rodar medialmente sobre o coto do
apêndice. Pontos Anatômicos: a válvula ileocecal representa uma protrusão de mucosa, submucosa e
15
camada muscular circular do íleo terminal no lúmen cecal. Essa válvula pode funcionar tanto ativa
como passivamente. A base do apêndice está usualmente a menos de 2 cm dessa válvula.
Autores de livros, não têm a pretensão de ensinar ao leitor a operar (exemplo:

apendicectomia). Eles descrevem cirurgias, porém não passo a passo (sequencialmente).
5d) Leia o texto acima (em português) e enumere (na 3ª pessoa do singular) cada passo
operatório deixando espaço de duas a cinco linhas entre eles. Então leia o texto em inglês e
adicione informações a cada “passo” ou mesmo adicione “passos”.
4º TEMA: biologia molecular

Parte 1
Fontes: James Darnell, et al. Molecular Cell Biology. Chapter 1. The Dynamic Cell. + Chapter 5. Cell organization,
subcellular structue and cell division. 3rd Edition. Scientific American Books Ed. New York. 1995.
The construction of cells:
Although generalizations in biology usually lack the theoretical underpinnings found in
physics, there are very clear commonalities among living systems that give biology a unity. One is the
style of cellular construction.
Cells Are Surrounded by Water-Impermeable Membranes
A cell, because it is a limited space, must have an outer border, and the construction of that
border represents one of the most fundamental considerations in biological organization. The outer
shell of cells, like any shell, is built to hold the interior contents from leaking out into the surrounding
environment. The chemical processes of cellular life generally take place in a watery solution, and the
intracellular constituents of cells are largely molecules that are easily dissolved in water. Similarly, the
environment around cells is a watery one, the blood and other bodily fluids being solutions in water.
Cells then, in order to maintain their integrity, need to be surrounded by an environment through which
water cannot flow. A membrane composed of fatty molecules serves this purpose.
16
We all know from common experience that “oil and water don’t mix.” That maxim is all one
needs to appreciate how a cell is constructed. When oil is poured on water, the oil spreads into a thin
film, and that film is analogous to the film of fat that surrounds cells. We call the film that limits a cell
its plasma membrane. Biological membranes differ from a pure oil film in that the molecules that
make the membrane have both oily and watery portions; they have long fatty chains, but they also have
a head group that is water-soluble by virtue of being electrically charged. Thus membranes are formed
because these bipartite molecules spontaneously orient themselves to form a double layer having a
fatty interior with external surfaces bonded to the surrounding water by the charged head groups
(Figure 1-5).
The membrane is given rigidity by interspersion of cholesterol molecules, a molecule we have

come to hate because of its association with heart disease, but one that is required to build the outer
membrane of all of our cells. Hence from an understanding of the contrasting properties of watery
solutions and oily layers, an understanding of cellular construction emerges.
In spite of the rigidity provided by cholesterol, membranes composed of fat are not very strong,
so numerous mechanisms for strengthening the borders of cells have evolved. In plants the plasma
membrane is surrounded by a rigid cell wall. Mammalian cells have proteins attached to their exterior
surfaces that provide integrity to tissues. Tissues and organs are often covered by strong networks of
proteins and other molecules to provide rigidity and protection and to wall off the various
compartments of the body. Single-celled organisms, like bacteria, have special outer coats to protect
them.
Membranes Serve Functions Other Than Segregation
Although membranes are valuable as a way to segregate the watery interior of the cell from its
environment, or to segregate intracellular events from one another, they have other important
functions; for one thing, they make energy storage possible. Because membranes separate watery
compartments from one another, if an ion of a molecule dissolved in water is moved through a
membrane into a new cellular compartment, it will not be able to freely diffuse out of the compartment
into which it was moved. It takes energy to move the molecule but, once moved, the molecule stores
that energy by virtue of its entrapment. Formally, this storage of energy is just like the storage of
energy in a battery; therefore, membranes not only delineate compartments, but also they are active
participants in the cell’s dynamism.
Another function of membranes is to act as anchors for molecules, primarily proteins. These
proteins have functions that require membrane-binding. For instance, the passage of water-soluble
molecules through membranes is carried out by transporters that are embedded in the membrane. Also,
17
cells send information to each other by releasing signaling molecules. The outer membranes of cells
have proteins, known appropriately as receptors, that bind the circulating signaling molecules. These
signaling molecules allow the individual activities of the many cells in the body to be coordinated. The
receipt of a signaling molecule by a receptor causes the transient organization of particular types of
intracellular proteins, called signal transduction proteins, into an activated complex at the interior face
of the cell’s outer membrane, from which it directs alterations of events in the cell’s cytoplasm or
nucleus.
Responda objetivamente (baseado apenas nas informações do texto acima):
1a) O colesterol confere rigidez às lâminas lipídicas. O texto acima cita outra “substância” que
também confere rigidez à membrana celular de animais (mamíferos). Cite-a (em português).
1b) Membranas biológicas são diferentes de lâminas de óleo, as membranas são compostas, de
fato, por partes hidrofílicas (aquosas-hidratadas) e hidofóbicas (oleosoas-lipídicas). Baseando-se
no texto acima, explique nas suas palavras (em português) como é a estrutura de uma membrana
celular (como desenhada na Figura 1-5 acima).
1c) A membrana celular tem outras funções que não apenas a de separar o meio externo do
interno da célula. Cite outras 3 (em português).
Parte 2
Eukaryotic Cells Contain Organelles Thought To Have Evolved as Independent Organisms
Another striking event that occurred during the evolution of nucleated cells was the import of
bacteria to become their energy-producing mitochondria and, in plant cells, chloroplasts. In today’s
world these organelles of the cell are dependent on functions encoded in the nucleus. However, they
retain some genetic funcitons of their own, so that nucleated cells today have multiple genetic systems
in them: a predominant system controlled from the nucleus and secondary systems with their own
DNA in the mitochondria and chloroplasts. In the organelles, the DNA is not surrounded by a nucleus,
reminding us of its bacterial origin. It is quite remarkable that the energy generation mechanisms of all
cells come directly from bacteria and were never separately evolved in higher cells.
Responda objetivamente (baseado apenas nas informações do texto acima) em português:
2a) O texto acima sugere que a mitocôndria não é uma estrutura “humana” originalmente mas
sim, fruto de um tipo de “simbiose” ancestral entre bactérias e células eucarióticas: Sim ou Não?
2b) Cite todas as frases do texto (em inglês ou em português) que justificam sua resposta.
Parte 3
The Molecules of Life
The life is a complicated orchestration of many events. These include a multitude of specific
chemical transformations, provision of sufficient energy, formation of organelles, movement of
materials to their appointed place in the cell, and growth and division when new cells are needed.
Many life-threatening diseases result from apparently small mistakes in these processes:
phenylketonuria when a dietary constituent cannot be digested; cystic fibrosis when an ion channel
made in the cytoplasm is unable to make its way to the cell surface; sickle cell disease when
hemoglobin precipitates inside red blood cells rather than being soluble; muscular dystrophy when a
molecule that should help organize the interior of muscle cells is not functional. To keep all cells in the
body in appropriate condition so that the whole organism can function requires complex and precise
directions.
To appreciate how evolution has provided the directions that allow the cell to carry out its
myriad activities, we need first to consider the implications of a central dichotomy of cellular life:
there are two fundamentally different types of molecules in cells, small molecules and
18
macromolecules, and they are formed in cells by two different types of synthetic processes. Small
molecules are made and altered by individual steps of chemical transformation; these can be so
extensive that a vegetarian diet can support the growth of an animal. Macromolecules, in contrast, are
linear polymers made by linking a defined set of small molecules (monomers) together through
repetitive use of a single chemical linkage step.
Small molecules and macromolecules play fundamentally different roles in the cell. The key
function of small molecules is to be the substrates for making macromolecules, and the cell is careful
to provide the mix of small molecules needed for macromolecular synthesis. Small molecules also do
things in their own right; for instance, they store and distribute the energy for all cellular processes,
and they are broken down to extract chemical energy, as when sugar is degraded to CO2 and H2O with
the release of the energy bound up in the molecule. Small molecules can act as signals to cells; nerve
cells communicate with each other by releasing and sensing small molecules, and the powerful effect
on our body of a frightening event comes from the instantaneous flooding of the body with a small
molecule hormone that mobilizes the “fight or flight response”.
Macromolecules, though, are the most interesting and characteristic molecules of living
systems; in a true sense the evolution of life as we know it is the evolution of macromolecular
structures. The chief macromolecules in the cell, in terms of variety of function, are the proteins.
Proteins are the “do-ers” of the cell; they catalyze small molecule transformations, allow cells to move
and do work, and maintain internal cell rigidity. Moreover, proteins control the genes that determine
cell constitution and function, move molecules across membranes, and even direct synthesis of
themselves and other macromolecules. They come in many shapes and sizes (Figure 1-7), and the
elucidation of their structure remains one of the most active areas of scientific investigation.
Proteins are actually polymerized from only 20 types of monomers (amino acids). That such a
limited set of building blocks can do so much is a continual marvel, even to those who work daily with
proteins. They are the true glory of the biological world.
The macromolecule about which we most often read in the news is not protein but DNA. This
molecule is extraordinary on many counts and thus easily captures the imagination of writers and even
artists. Not only does its double-helical structure make it one of nature’s most magnificent
constructions, but its functional properties also make it the cell’s master molecule. It contains a coded
representation of all of the cell’s proteins; other molecules like sugars or fats are made by proteins, so
their structures are indirectly coded in DNA. It also contains a coded set of instructions about when the
19
proteins are to be made and in what quantities. DNA does all of this using only four types of
monomers (nucleotides) arrayed in one to 50 or more strings called chromosomes, each containing
many millions of nucleotide units.
Responda em português (conforme os textos e figuras acima):
3a) MOLECULAS DA VIDA: são as micro ou as macromoléculas?
3b) Justifique sua resposta em “3a” com o que você compreendeu no texto e figuras.
3c) O texto acima cita 6 funções das proteínas. Cite 5 delas (use Infinitivo).
3d) O DNA codifica apenas a produção de proteínas. Então como uma célula humana produz
lipidios e carbohidratos, também?
Parte 4
Genetics Allowed DNA Organization to be Analyzed Before the Structure of DNA was
Discovered
Since DNA is simply a long string of four different small molecules arrayed in a sequence that
encodes the cell’s information, extracting the information held in the molecule is a problem of
daunting complexity. Even now that we can determine the sequence in long stretches of DNA,
understanding the information in a piece of DNA is difficult because so many different events are
encoded there. Some of DNA is devoted to encoding protein structure, but much of it is devoted to
controlling when and how much of each protein is made. The fact that sequences encoding proteins are
often broken up by non-coding sequences adds more complexity. Furthermore, the control instructions
written in DNA can be very subtle, and we are far from understanding all of them even today…
4) Há sequencias gênicas no DNA que não codificam proteinas, a que elas se prestam?
.
Parte 5
The Ultimate Triumph of Genetics Is The Human Genome Project
Today there is a productive interplay between genetics, which views genes as abstract units
along a string, and molecular biology, which views genes as chemical entities. Nowhere is that
interplay more evident than in the Human Genome Project, one of humankind’s most ambitious and
exciting scientific undertakings. The Human Genome Project is a commitment by the American
scientific community, in partnership with the government, to determine the location and structure of all
of the genes in the human chromosomes (We can the total nuclear DNA complement of an organism
its genome). This project will lead, perhaps early in the twenty-first century, to a knowledge of the
complete sequence of all of the DNA in the human genome. The American effort is part of an
international effort coordinated by the Human Genome Organization. Because human genetics is
particularly difficult, due to the obvious inability to control breeding, and because so much of our
knowledge of even human biology comes from the study of non-human systems, the Human Genome
Project includes extensive work on the DNA of many organisms of experimental interest. For each
organism, scientists are making higher and higher resolution maps, locating defined pieces of DNA
relative to one another. In 1994 the maps of the human chromossomes already had thousands of
recognizable pieces of DNA mapped relative to one another.
The goals of the Human Genome Project are multiple, and they illustrate how biology today
has evolved into a science that is moving ahead both conceptually and practically. The cell biologist of
tomorrow will work with a complete catalog of the genes in an organism of interest, allowing the set of
the genes making proteins relevant to a particular cellular event to be reliably predicted and their
structure to be immediately known. Also, the Project already has moved from a focus on genes of
experimental organisms and humans to mapping genes in organisms of commercial or health interest,
like tomatoes or the bacterium that causes tuberculosis. Maps of human DNA allow us to locate genes
of medical importance, those, for example, that cause specific diseases such as cystic fibrosis.
20
Understanding the genomes of bacteria might facilitate identification of targets for which chemists
could design new antibiotics, a particular hope with tuberculosis, a disease that is now often resistant
to all known therapeutic agents. Maps of plants could help us locate genes that underlie important
commercial traits, like fruit weight, that could then be incorporated into more productive plants. Soon
the Human Genome Project should allow scientists to identify genes that are responsible for
complicated human problems such as obesity or heart disease.
The Human Genome Project is a testament to the power that modern biology has achieved both
as a theoretical and a practical science. Because the Project is focused on human genes, however, its
success raises difficult issues for the scientific community and the world at large about how much we
want to understand our own genetic constitution when that information might be used, for instance, to
limit our access to insurance or employment. The Human Genome Project is going to show that each
of us, no matter how healthy we seem, harbors deleterious genes, so that we all run the risk of
discrimination. Realizing the potential of modern biology while defining and limiting the inappropriate
use of the information is a challenge to both our science and our society.
Responda objetivamente, em português:
5a) Defina o Projeto Genoma (não desperdice as informações objetivas do texto).
5b) Conhecer genes envolvidos em doenças como as cardiopatias e obesidade para a sua melhor
prevenção e para introduzir novas terapias são dois desdobramentos da mesma meta (conhecer
melhor as doenças do Ser Humano). Porém esse conhecimento pode ter desdobramentos não
éticos que o texto cita. Cite em suas palavras esses “desdobramentos ruins possíveis”.
. Parte 6
RNA Is the Molecule That Is the Product of the Genome
The Human Genome Project will bring us detailed knowledge of human DNA and will provide
a great resource for experimental biologists. However, it will also bring to biology a formidable
challenge: to fit all of the human genes into a framework within which their particular functions can be
understood. Genes actually do not specifically direct synthesis of proteins; they do it through an
intermediate. Genes are the template for the synthesis of proteins; they do it through an intermediate.
Genes are the template for the synthesis of RNA, a molecule chemically very similar to DNA, but one
that serves functions very different from those of DNA. Some RNA molecules are products of genes
that do not encode proteins and directly serve roles similar to those of proteins: catalyzing chemical
reactions or providing a structural scaffold for building multi-protein aggregates. RNA’s most
important role, however, is to act as a template for the synthesis of specific proteins, leading us to the
so-called Central Dogma of biology: DNA specifies RNA, which specifies protein.
Using computer language, biologists often say that the synthesis of RNA represents a “read-
out” of the genome. Each cell of the body reads out a subset of the information in the genome,
providing itself with the set of RNAs and proteins it needs to fulfill its particular role in the body.
Because our nervous system is our most complex part, it uses a larger fraction of the total information
in the genome than does any other tissue type. Selective RNA synthesis is perhaps the most
fundamental activity of the cell. So the Human Genome Project will give us all the genes, but until we
understand cell-specific RNA synthesis, as well as the properties of the encoded proteins, we will not
be able to appreciate how the DNA actually makes a cell.
Responda em português (baseado apenas nas informações do texto acima):
6) Explique o que é o RNA e sua atuação na célula humana.
21
5º TEMA: temas em alta tecnologia biomédica
Parte 1
About Nanotechnology
Richard Feynman is often credited as the person who initiated the conceptual underpinnings of
nano technology, before the term was coined. Although many physicists who were working in the
quantum realm arrived at perhaps similar conclusions, his lecture, “There is Plenty of Room at the
Bottom”, in 1959, is used as a historical marker for the conceptualization of nanoscience and
technology. Indeed, it is interesting to note that this was not an invention per se, but more a shift of
focus or attention generated by a flamboyant personality that is interpreted to initiate the advent of
nanotechnology.
Much of Feynman’s visions really took hold in the early eighties when nano science and
technology truly took off in 1981, Heinrich Rohrer and Gerd Binning, at IBM Zurich research
laboratories, invented the Scanning Tunneling Microscope (STM), which for the first time “looked” at
the topography of atoms that cannot be seen.
With this invention, the age of the immaterial was truly inaugurated. Not much later, in 1984, a
molecule was discovered by Sir Harry Kroto, Richard Smalley and Robert Curl that truly got the ball
rolling. Buckminsterfullerene named after Buckminster Fuller, an architect, engineer, philosopher
whose dome structures employed geometries found in natural structures.
Not coincidentally, the IBM PC was taking center stage and causing a true revolution in arts
and sciences alike. In a short period of history, many new things appeared, creating a perfect
environment for a natural symbiosis between science, technology and art. Another decade would pass
before people occupying these creative worlds would expand their perceptual field to include each
other’s points of views. Indeed, the surge of this expansion happened from a genuine need to embrace
and cross-pollinate research and development between science, technology and art.
New Vision: the STM - a symbol of the shift from visual to tactile perception
Up until the mid-nineteen eighties, scientists viewed matter, atoms, molecules, and solids using
various types of microscopes or in abstract space.
The wide spread use of optical microscopes had begun in the 17 th Century, enabling people like
Galileo to investigate matter through magnification by factors of hundreds. These microscopes relied
on lenses and the properties of light as a wave. Waves were manipulated by lenses to magnify and
create an image in the viewer’s eye, providing information on how light is reflected or transmitted
through an object.
Typically, human perception of a microscope is a tube-like structure through which one looks
and sees reality magnified. In a deeper philosophical sense, while being strictly scientific, the concept
of “seeing’ is illusory. Nevertheless, when one looks through a microscope at a butterfly’s wings, it is
difficult to separate ones’ conscious mind and its interpretation from the information transmitted by
22
ones’ eyes. The eye itself contains a small part of the brain that already preprocesses the information
received as light particles, or waves.
As the magnifying power of the microscope increased, the average person looking through the
lenses maintains his or her illusion of seeing a reality, and interprets the image in terms of common
human experience related to the scale in which one normally observes the world.
The Scanning Tunneling Microscope represents a paradigm shift from seeing in the sense of
viewing, to tactile sensing - recording shape by feeling, much like a blind man reading Braille. The
operation of a STM is based on a quantum electron tunneling current, felt by a sharp tip in proximity to
a surface at a distance of approximately one nanometer. The tip is mounted on a three dimensional
actuator like a finger as shown schematically in Figure “1a” and “1b”.
Figura 1
Principle of a scanning tunneling microscope uses a local probe: The gentle touch of a nanofinger is shown in (a)
where if the human finger was shrunk by about ten millions times it would be able to feel atoms represented here (a -
left image) by spheres 1 cm in diameter. If the interaction between tip and sample decays sufficiently rapidly on the
atomic scale, only the two atoms that are closest to each other are able to “feel” each other as shown in (b) where the
human finger is replaced by an atomically sharp tip. Binnig and Rohrer (1999) inspired this explanation of the
Scanning Tunneling Microscopy.
This sensing is recorded as the tip is mechanically rastered across the surface producing
contours of constant sensing (in the case of STM this requires maintaining a constant tunneling current
– Figure 2). The resulting information acquired is then displayed as an image of the surface
topography. Figure 4.
Figura 2
O fundamento físico para a geração de imagem na escala nanométrica.

.
Figura 3
23
O equipamento de geração de imagem na escala molecular (nanométrica) e um exemplo de imagem gerada (sempre em
preto e branco) pelo toque-e-retirada da ponteira (probe) do microscópio em uma superfície moldável.
.
Figura 4
The STM records images of surfaces and molecules as a two dimensional data set of heights. Here an ordered array of
molecules called hexa-butyl decacyclene, each around 1 nanometer is size were recorded by the STM. The resulting
data were then plotted as a gray scale image representing the apparent height of the molecules. Each molecule is
represented as six lobes in a distinct hexagonal pattern with a dark central portion. Interestingly this height maps does
not represent the real height of the atoms but rather the probability of parts of the molecule to convey electrons by
quantum tunneling to the tip. The casual observer tends to see the pattern as representing the shape of the molecule.
Through images constructed from feeling atoms with an STM, an unconscious connection to
the atomic world quickly becomes automatic to researchers who spend long periods of time in front of
their STMs. This inescapable reaction is much like driving a car - hand, foot, eye, and machine
coordination becomes automated. Similarly, the tactile sensing instrument soon became a tool to
manipulate the atomic world by purposefully moving around atoms and molecules and recording the
effect which itself enabled exploration of interesting new physical and chemical processes on an
molecule -by- molecule basis, as seen in Figures “3a” and “3b”.
By 2003, a whole range of microscopes based on tactile sensing had been developed, and many
companies were established to manufacture machines that are used by microelectronics and data
storage industries. Worldwide sales of these machines are in the range of a billion dollars.
The new tactile techniques opened up a radically new approach to microscopy enabling real
local properties to be imaged and mapped. For instance, ultra high-resolution images of local
magnetism like bits of north and south directed domains could be obtained with magnetic tips.
If friction was an issue, images of local friction as it scanned the surface could be mapped. This
opened up a new world, a world never really seen before on those terms - the nanoworld. Even bigger
consequences of “touching” rather than looking were also realized, as seen in Figure 3a-b.
The environment in which once could image at really high resolving power, with the wave
microscopes was limited to a vacuum so that biological objects were dead and perturbed from their
natural state. This was a major drawback that limited the interpretation of microscope images of
24
biological samples. The new tactile microscopes were not subject to such limitations. Consequently, it
was possible to image in vivo what is under physiological conditions on live specimens.
It was possible to image the electrodes of batteries as they worked in their acidic environment.
Our windows on the nanoworld looked not at parts of systems, but really at operating fully functional
systems, allowing their complexity to be “seen” and measured all the way up from the nanoscale of
individual atoms and molecules.
Through the paradigm shift in microscopy, the tactile probes which were now being called
scanned probe microscopies (SPM) opened up yet one more feature, which had been the “Holy Grail”
of a mad dream. The idea to manipulate and move single atoms and molecules in a controlled manner,
up until the mid nineteen eighties, was something outside of general scientific plausibility. In fact, the
famous scientist Erwin Schroedinger wrote that we would never experiment with just one electron,
atom, or molecule. This view, like concepts of statistical mechanics which viewed matter as a
collective property of atoms and molecules, required a rebel to question its almost religious doctrine.
Eight years later, Richard P. Feynman told us that there are no physical limitations to arranging atoms
the way we want, but he was pretty alone when he said it.
.
“Microscopia de Varredura por Tunelização (MVT)” é uma versão em português para “Scanning
Tunneling Microscope (STM)”. Para obter-se essa “versão”, foi necessário ler textos científicos
brasileiros em paralelo porque somente com as traduções literais isso não seria possível. Essa
dificuldade é recorrente em temas desconhecidos do leitor ou temas de inovação tecnológica.”
1a) Dê a sua versão (expressão) em português para “early eighties”.
1b) Dê a sua versão (expressão) em português, válida no contexo acima para “…to embrace and
cross-pollinate…”.
1c) Dê a sua versão (expressão) em português para “nanoscale”.
Analise as afirmações abaixo e compare com as informações contidas no texto acima. Julgue
verdadeiras (V) ou falsas (F) e cite o fragmento do texto (em inglês) que você usou para
fundamentar seu julgamento:
1d) A nanotecnologia é um ramo da Ciência que foi inaugurado após o ano 2001 (nesta última
década).
1e) A microscopia óptica é, aproximadamente, 300 anos mais antiga que a microscopia de
varredura por tunelização.
1f) A ponteira do microscópio de varredura analisa uma estrutura tridimensionalmente mas o
equipamento faz a “transdução – tradução” para uma imagem bidimensional em tons de cinza.
1g) As técnicas ópticas de microscopia apoiam-se no princípio físico da “reflexão luminosa
sobre as estruturas no foco da análise com uma “magnificação” promovida por uma lente - lupa
para, então, a sua captação pela lente ocular (olho – visão) humana do analisador que gera, a partir
da sensação de imagem, uma interpretação neural da imagem”.
1h) A Microscopia por Ponteira de Varredura (scanning probe microscopy) pode viabilzar a
retificação de posição de um átomo em uma molécula. Erwin Schroedinger e Richard P. Feynman
discordavam, entre si, sobre isso.
Parte 2
Nanotechnology has a great potential in revolutionizing the drug delivery field, but realizing
such a potential requires harmonized efforts among scientists in different disciplines and continued
support by funding agencies.
25
As shown in Table 1, the future of nanotechnology-based drug delivery systems depends on the
ability of scale-up production by nano/micro manufacturing. This requires design of the simplest
possible delivery systems, and this will be possible only through intimate communication between
nanofabrication engineers and drug delivery scientists.
Nanotechnology for drug delivery will ‘mature faster and become more useful if we appreciate
that the real potential of nanotechnology in drug delivery is based on utilization of nano/micro
fabrication and manufacturing, rather than on dealing with delivery systems in the nano/micro scale.
.
Table 1: Examples of drug delivery technologies in relation to the current nanotechnology revolution.
Mature Nanotechnology
Period Before Nanotechnology (Past) Transition Period (Present)
(Future)
Emulsion-based preparation
Technology of nano/micro particles Nano/micro fabrication Nano/micro manufacturing
 Liposomes  Microchip systems

 Polymer micelles  Microneedle transdermal
 Dendrimers delivery systems  Nano/micro machines
Examples for scale-up
 Nanoparticles  Layer-by-layer assembled production
 Nanocrystals systems
 Microparticles  Microdispensed particles
2) O texto acima poderia ser mais elucidativo quanto ao conteúdo da “Table 1”, certamente.
Porém, leia o texto e a tabela e a partir daí explique (em suas palavras, em português: 2 a 10 linhas)
a diferença entre nanofabricação (fabrication) e nanomanufatura (manufacturing), que são os
diferenciais entre o “estado da arte” de momento da Industria que desenvolve “nanodelivery drug
systems” e o que a Indústria poderá se tornar capaz de gerar no future neste ramo específico da
Farmacologia.
Parte 3
About Drug Delivery Systems and new/revolutionaries administration ways

Possible Uses of Microneedles
Microneedles sit at the interface between transdermal patches and hypodermic needles, attempting to
gain the advantages and eliminate the disadvantages of each. Hypodermic needles effectively deliver
almost any drug at almost any rate across the skin but are limited by pain, need for medical expertise,
and difficulty to have controlled delivery over long periods of time.
26
In contrast, transdermal patches largely eliminate these limitations, but suffer from an inability to
deliver most drugs across skin at useful rates.
We have hypothesized that microneedles may be small enough to capture the convenience of patches
but large enough to create micrometer-scale pathways across the skin for drug delivery.
Previous studies have shown that microneedles can be painlessly inserted into the skin of human
subjects. Additional studies will be needed to further establish the ease and efficacy of microneedle-
based delivery in a clinical environment.
We envision using solid microneedles in combination with current transdermal patch technology.
Integrated into a patch, microneedles may provide a minimally invasive method to increase skin
permeability for diffusion-based transport that could make transdermal delivery of many drugs
possible, including large molecules such as proteins. Hollow microneedles, either as individual needles
or as multineedle arrays, might be used for convection-based delivery. This microinfusion approach
could increase rates of delivery beyond those of passive patches and permit rates to be modulated in
real time by a microprocessor-controlled pump, which could include a user interface for input by
patients or healthcare providers.
Advantages of Metal and Polymer Microneedles
Although silicon needle arrays (Figures below) can be fabricated in cleanroom facilities in
widespread use in the microelectronics industry, the metal and polymer needles shown in figures
below offer a number of practical advantages.
Figura 5
Solid microneedles fabricated out of silicon, polymer, and metal, imaged by scanning electron microscopy.
(a) Silicon microneedle (150 μm tall) from a 400-needle array etched out of a silicon substrate.
(b) Section of an array containing 160,000 silicon microneedles (25 μm tall).
(c) Metal microneedle (120 μm tall) from a 400-needle array made by electrodepositing onto a polymeric
mold.
(d-f) Biodegradable polymer microneedles with beveled tips from 100-needle arrays made by filling
polymeric molds.
(d) Flat-bevel tip made of polylactic acid (400 μm tall).
(e) Curved-bevel tip made of polyglycolic acid (600 μm tall).
(f) Curved-bevel tip with a groove etched along the full length of the needle made of polyglycolic acid (400
μm tall).
.
Figura 6
27
Optical micrographs showing molecular transport induced by microneedles.
(a) An array of microneedle (Figure 1 - A) was inserted and removed from human cadaver skin, which was
subsequently exposed to trypan blue on the exterior stratum corneum side.
(b) The array of dark dots shown on the interior viable epidermis side indicates that microneedles created transport
pathways across the tissue.
.
Figura 7
Hollow microneedles fabricated out of silicon, metal, and glass imaged by optical and scanning electron microscopy.
(A) Straight-walled metal microneedle from a 100-needle array fabricated by electrodeposition onto a polymer mold
(200μm tall).
(B) Tip of a tapered, beveled, glass microneedle made by conventional micropipette puller (900-μm length shown).
(C) Tapered, metal microneedle (500 μm tall) from a 37-needle array made by electrodeposition onto a polymeric
mold.
(D) Array of tapered metal microneedles (500 μm height) shown next to the tip of a 26-gauge hypodermic needle.
First, fabrication of metal and polymer microneedles should be less expensive and readily
scalable to mass production because: (i) metal and polymer raw materials are widely available and
generally less expensive than silicon wafers, (ii) the electroplating and polymer molding techniques
used to make these needles can be set up in a conventional manufacturing environment without the
need for cleanroom facilities, and (iii) the fabrication techniques we developed involve relatively
simple single-step molding operations, which contrasts with most other published methods that require
more complex multistep fabrication schemes.
And regarding microneedle safety, many metal and polymer materials have established safety records
in medical devices, whereas silicon is a new and relatively untested biomaterial. In contrast to our
previous observations of occasional breakage of silicon microneedle tips upon insertion into skin, our
28
polymer and metal microneedles are stronger. As an added safety measure, polymer microneedles
were fabricated by using biodegradable materials, which suggests that if such a microneedle
accidentally broke off in the skin, it would safely degrade and disappear over time.
In conclusion, practical microfabrication techniques were developed to yield silicon, metal, and
polymer microneedles of micrometer dimensions in various geometries. Solid microneedles were
shown to pierce skin and thereby increase skin permeability by orders of magnitude to levels that may
permit clinical delivery of macromolecules across skin. Solid needles also permeabilized cell
membranes for intracellular delivery of marker compounds. Hollow microneedles were shown to
microinject insulin to modulate blood glucose levels in diabetic rats. Together, these results suggest
that microneedles are a useful approach to transdermal drug delivery.
O texto anterior afirma que as micro e as nano-agulhas de metal apresentam vantagens de natureza fabril (facilidade de moldar e baixo custo da
matéria-prima), biocompatibilidade (moléculas constituintes que são naturais nos organismos vivos, como o Ferro, Zinco, Cobre, Magnésio e a
possibilidade de degradação pelo organismo que os autores afirmam “não deixar vestígios” depois de um certo tempo). A figura 5 apresenta a
agulhas sólidas que foram usadas sobre a pele íntegra (figura 6) e a perfuraram simetricamente na camada córnea exclusivamente.
A aplicação sobre a pele de um dispositivo com essas micro-agulhas foi capaz de abrir “poros” na camada córnea da pele (figura 6a) que
viabilizaram a livre passagem de um líqudo (Azul de Tripan) diretamente através da barreira córnea atingindo camadas mais profundas da
epiderme. Já a figura 7 apresenta a mesma agulha, porém fenestrada (oca). O que viabiliza a introdução de um produto através desses canais
agulhados permanentes (ou duráveis enquanto o processo de biodegradação do tecido permitir).
3) Crie (livremente) uma hipótese inédita para dispositivo de micro-perfuração tissular

(associado ou não a outro equipamento dispensador) em um tipo de paciente específico
fundamentando sua ideia nos conceitos, informações e teorias apresentados no texto desta aula:
duas a dez linhas, em português, termos técnicos, texto objetivo com “gramática” científica .
.
Parte 4
New Nanotechnology-Enhanced Cosmetics: A Health Risk for Women?
The use of nanotechnology in consumer products continues to grow steadily: According to the
Project on Emerging Nanotechnologies (PEN) over 1,300 manufacturer-identified products containing
nanotechnology are commercially available on the worldwide market. The most recent update to the
group's five-year-old inventory reflects the increasing use of the tiny particles in conventional
household items.
Over half the products on the PEN list are health and fitness items. Most of these products
contain nanoscale silver, used for its antimicrobial and sunscreening properties.
According to Science Daily, Dr. Todd Kuiken, a research associate with PEN, says of the
problem of nanotechnology regulation, "Despite ten years and billions of dollars of investment through
the National Nanotechnology Initiative, oversight challenges … still exist."
In other words, although an increasing number of nano-products are becoming available, the
nanotechnology industry currently operates without any agreed-upon industry-wide guidelines for
environmental health or safe research strategies. So, consumers should be wary.
Women: Major Users of Nanotechnology-Enhanced Cosmetics:
What does this mean for women, the major users of cosmetics? A close look at the inventory is
especially important to help them make informed decisions when choosing cosmetic products that use
nanotechnology. Listed on the PEN inventory under the health and fitness category were creams,
lotions, and other beauty products from many major cosmetic companies, including Chanel, Lancome,
Dior, and Shiseido.
As with any new technology, it is helpful for the consumer to be cautious and well-informed
about its effects, especially when governmental regulatory guidelines are not yet well-established. The
PEN inventory, the most comprehensive and widely used source of information on nanotech-enabled
consumer products in the world, is one of the best resources for this.
PEN (Project to Emerging Nanotechnology) atua como um grupo privado de consultoria para
29
assuntos de natotecnologia prestador de serviços para ONGs, governos, cidadãos em geral.
4) O PEN alerta a comunidade leiga (consumidores) para que se preste atenção aos novos
produtos cotidianos de saúde, bem estar e beleza. Lendo o texto inteiro e contextualizando em seus
conhecimentos médicos de farmacologia (cosmética, cosmecêutica e terapia), legislação para
atuação médica e registro de produtos de efeitos terapêuticos, cosmecêuticos e cosméticos qual a
falha na interlocução Medicina e Indústria que está ocorrendo (responda em suas palavras,
individualmente, 2 a 10 linhas)?
6º TEMA: Farmacologia
Parte 1
 About FDA Organization:

FDA is an agency within the Department of Health and Human Services.
The FDA is responsible for protecting the public health by assuring the safety, efficacy, and
security of human and veterinary drugs, biological products, medical devices, our nation’s food
supply, cosmetics, and products that emit radiation, and by regulating the manufacture, marketing, and
distribution of tobacco products.
The FDA is also responsible for advancing the public health by helping to speed innovations
that make medicines and foods more effective, safer, and more affordable; and helping the public get
the accurate, science-based information they need to use medicines and foods, and to reduce tobacco
use to improve health.
Analise as afirmações abaixo e compare com as informações contidas no texto acima.
Julgue verdadeiras (V) ou falsas (F) e cite o fragmento do texto (em inglês) que você usou
1a) O “FDA” é uma agência norte americana que se responsabiliza pelos insumos à saúde
humana e veterinária.
1b) O “FDA” regula desde a produção, a publicidade, até a distribuição de cigarros no país.
Parte 2
30
 Organization:
The FDA's organization consists of the Office of the Commissioner and four directorates overseeing
the core functions of the agency: Medical Products and Tobacco & Foods, Global Regulatory
Operations & Policy and Operations:
1. Office of the Commissioner
a) Office of Medical Products and Tobacco (OMPT)
b) Office of Foods (OF)
c) Center for Tobacco Products
d) Center for Veterinary Medicine
e) Office of Special Medical Programs
f) Center for Biologics Evaluation and Research (CBER)
CBER is the Center within FDA that regulates biological products for human use under
applicable federal laws, including the Public Health Service Act and the Federal Food, Drug and
Cosmetic Act. CBER protects and advances the public health by ensuring that biological products are
safe and effective and available to those who need them. CBER also provides the public with
information to promote the safe and appropriate use of biological products.
g) Center for Devices and Radiological Health
h) Center for Drug Evaluation and Research (CDER)
CDER performs an essential public health task by making sure that safe and effective drugs are
available to improve the health of people in the United States. As part of the U.S. Food and Drug
Administration (FDA), CDER regulates over-the-counter and prescription drugs, including biological
therapeutics and generic drugs. This work covers more than just medicines. For example, fluoride
toothpaste, antiperspirants, dandruff shampoos and sunscreens are all considered "drugs."
i) Office of Global Regulatory Operations and Policy (OGROP)
j) Office of International Programs
k) Office of Regulatory Affairs
l) Office of Operations (OP)
m) Office of Information Management
n) Office of Management
o) Office of Equal Employment Opportunity
p) Office of Finance, Budget and Acquisition
2a) Dê a sua versão em português, no contexto acima, para “over-the-counter drugs” e para
“prescription drugs”.
Analise a afirmação abaixo e compare com as informações contidas no texto acima. Julgue
2b) O FDA classifica xampu e pasta de dentes como drogas.
Parte 3
 Diferenças entre os conceitos das legislações e normas brasileiras e norte-americanas:
Brasil United States of America
(Agência de Vigilância Sanitária – ANVISA) (Food and Drug Administration – FDA)
Droga Drug
Substância ou matéria-prima que tenha The FD&C Act defines drugs, in part, by their intended
31
finalidade medicamentosa ou sanitária. use, as "articles intended for use in the diagnosis, cure,
mitigation, treatment, or prevention of disease" and "articles
(other than food) intended to affect the structure or any
Medicamento function of the body of man or other animals".
Produto farmacêutico, tecnicamente obtido ou
elaborado, com finalidade profilática, curativa,
paliativa ou para fins de diagnóstico. Pharmaceutic
Pharmaceutical is a drug derived from organic or
inorganic chemicals and used to treat a wide range of
Insumo Farmacêutico medical conditions.
Droga ou matéria-prima aditiva ou
complementar de qualquer natureza, destinada a
emprego em medicamentos, quando for o caso, Active Pharmaceutical Ingredient (API)
ou em seus recipientes. Any substance that is represented for use in a drug and
that, when used in the manufacturing, processing, or
packaging of a drug, becomes an active ingredient or a
Correlato finished dosage form of the drug. Such substances are
Substância, produto, aparelho ou acessório intended to furnish pharmacological activity or other direct
não enquadrado nos conceitos anteriores, cujo effect in the diagnosis, cure, mitigation, treatment or
uso ou aplicação esteja ligado à defesa e proteção prevention of disease, or to affect the structure and function
da saúde individual ou coletiva, à higiene pessoal of the body of humans or other animals. APIs include
ou de ambientes, ou a fins diagnósticos e substances manufactured by processes such as (1) chemical
analíticos, os cosméticos e perfumes, e, ainda, os synthesis; (2) fermentation; (3) recombinant DNA or other
produtos dietéticos, óticos, de acústica médica, biotechnology methods; (4) isolation/recovery from natural
odontológicos e veterinários. sources; or (5) any combination of these processes.
Cosmético Drug Delivery

O de uso externo, destinado à proteção ou ao The process by which a formulated drug is administered
embelezamento das diferentes partes do corpo, to the patient. Traditional methods have been orally or by
tais como pós faciais, talcos, cremes de beleza, injection. Newer methods include through the skin by
creme para as mãos e similares, máscaras faciais, application of a transdermial patch, or across the nasal
loções de beleza, soluções leitosas, cremosas e membrane by administration of a specially formulated nasal
adstringentes, loções para as mãos, bases de spray.
maquilagem e óleos cosméticos, rouges, blushes,
batons, lápis labiais, preparados anti-solares,
bronzeadores e simulatórios, rímeis, sombras, Medical Device
delineadores, tinturas capilares, agentes A device is: an instrument, apparatus, implement,
clareadores de cabelos, fixadores, laquês, machine, contrivance, implant, in vitro reagent, or other
brilhantinas e similares, tônicos capilares, similar or related article, including a component part, or
depilatórios ou epilatórios, preparados para unhas accessory which is:
e outros. a) recognized in the official National Formulary, or the
United States Pharmacopoeia, or any supplement to them,
Nutrimento b) intended for use in the diagnosis of disease or other
Substância constituinte dos alimentos de valor conditions, or in the cure, mitigation, treatment, or
nutricional, incluindo proteínas, gorduras, prevention of disease, in man or other animals, or
hidratos de carbono, água, elementos minerais e c) intended to affect the structure or any function of the
vitaminas. body of man or other animals, and which does not achieve
any of it's primary intended purposes through chemical
action within or on the body of man or other animals and
which is not dependent upon being metabolized for the
achievement of any of its primary intended purposes.
Cosmetic
The Federal Food, Drug, and Cosmetic Act defines
cosmetics by their intended use, as "articles intended to be
32
rubbed, poured, sprinkled, or sprayed on, introduced into,
or otherwise applied to the human body...for cleansing,
beautifying, promoting attractiveness, or altering the
appearance". Among the products included in this
definition are skin moisturizers, perfumes, lipsticks,
fingernail polishes, eye and facial makeup preparations,
cleansing shampoos, permanent waves, hair colors, and
deodorants, as well as any substance intended for use as a
component of a cosmetic product.
Food
Articles used for food or drink for man or other animals,
(2) chewing gum, and (3) articles used for components of
any such article.
ATENÇÃO – O Quadro anterior NÃO apresenta informações equivalentes do inglês para o português mas sim
equivalência do texto regulamentador dos dois países (Brasil e Estados Unidos).
NOTA – Dicionários (não técnicos) traduzem “medicamento” como medicine, drug, medicament, remedy.
Remedy ou remédio? Entende-se como remédio: qualquer medida ou terapia com ou sem o uso de substâncias
químicas para tratar doença (ex.: prescrição médica, fisioterapia, meditação e outros “comportamentos”). Deve-se
saber que alguns termos são reconhecidos e definidos pela legislação e normas técnicas do Sistema de Saúde de cada
país; e outros, são de uso meramente cotidiano (para leigos). E isso pode gerar confusões ao traduzir termos como
“medicamento”.
Medicamento, no Brasil e segundo a ANVISA, possui uma definição diferente de “droga”, já nos EUA não há termos
equivalentes que diferenciem drugs de medicines. E para dificultar, ainda mais a vida do médico que lê textos em
inglês, a palavra medicine pode ser traduzida ao português como “medicamento” ou “medicina”.
3a) O termo CORRELATO se assemelha a qual termo definido pelo FDA? Dê sua versão em
português para a definição do FDA escolhida por você.
3b) Você considera que o termo FOOD é equivalente ao termo NUTRIMENTO? Dê sua versão
em português o termo FOOD para: I - um texto técnico médico nacional e II – um texto técnico
porém para leigos.
3c) Dê a sua versão ao português para a palavra “drug delivery” no contexto acima.
Parte 4
 What is the approval process for a new prescription drug?
Drug companies seeking FDA approval to sell a new prescription drug in the United States must test it
in various ways. First are laboratory and animal tests. Next are tests in humans to see if the drug is safe
and effective when used to treat or diagnose a disease.
After testing the drug, the company then sends FDA an application called a New Drug
Application (NDA).
Some drugs are made out of biologic materials. Instead of an NDA, new biologic drugs are approved
using a Biologics License Application (BLA). Whether an NDA or a BLA, the application includes:
1. the drug's test results
2. manufacturing information to demonstrate the company can properly manufacture the
drug
3. the company's proposed label for the drug. The label provides necessary information
about the drug, including uses for which it has been shown to be effective, possible risks, and how to
use it.
33
If a review by FDA physicians and scientists shows the drug's benefits outweigh its known risks and
the drug can be manufactured in a way that ensures a quality product, the drug is approved and can be
marketed in the United States.
Step by step:
1. Preclinical (animal) testing.
2. An investigational new drug application (IND) outlines what the sponsor of a new
drug proposes for human testing in clinical trials.
3. Phase 1 studies (typically involve 20 to 80 people).
4. Phase 2 studies (typically involve a few dozen to about 300 people).
5. Phase 3 studies (typically involve several hundred to about 3,000 people).
6. The pre-NDA period, just before a new drug application (NDA) is submitted. A
common time for the FDA and drug sponsors to meet.
7. Submission of an NDA is the formal step asking the FDA to consider a drug for
marketing approval.
8. After an NDA is received, the FDA has 60 days to decide whether to file it so it can
be reviewed.
9. If the FDA files the NDA, an FDA review team is assigned to evaluate the sponsor's
research on the drug's safety and effectiveness.
10. The FDA reviews information that goes on a drug's professional labeling
(information on how to use the drug).
11. The FDA inspects the facilities where the drug will be manufactured as part of the
approval process.
12. FDA reviewers will approve the application or issue a complete response letter.
O texto acima apresenta um roteiro (cronograma) de atividades-tarefas a serem cumpridas por
uma Empresa Farmacêutica para aprovação de uma nova droga.
4a) O que deve conter um Requerimento de Registro de Nova Droga ou Licenciamento de
Produto Biológico? (Responda em português)
4b) No “passo a passo” para a liberação de um novo medicamento pelo FDA há um passo em
que a Indústria-Empresa Farmacêutica pode se reunir com uma equipe técnica do próprio FDA
para uma “pré-avaliaçao” da proposta.
.
Parte 5
34
 Driving Biomedical Innovation: Initiatives for Improving Products for Patients
FDA released a report containing immediate steps that can be taken to drive biomedical innovation,
while improving the health of Americans. The report addresses concerns about the medical product
development pipeline, one of the most pressing challenges facing the biomedical industries.
Release of the report, kicks off a new FDA-wide Innovation Initiative, which promises to redouble
the agency’s efforts to encourage innovations that will promote public health as well as strengthen the
American economy.
We are committed to continuing our dialogue with companies, innovators, patients, and other
stakeholders to identify barriers to progress and better define what steps need to be taken to overcome
any obstacles to innovation.
5) O relatório “Conduzindo a Inovação Biomédica” do FDA visa barrar abusos de conduta da
indústria farmacêutica norte americana.

7º TEMA: Fisiologia médica
Parte 1
MEMBRANE POTENTIALS
I. Introduction
A membrane potential (EM) is the electrical energy difference between the inside and outside of
the cell. It is measured in millivolts (mV). The membrane potential is produced by the separation of
charge. Charge separation can occur in either an equilibrium or a steady-state condition.
II. Equilibrium Potentials
Equilibrium potential is the membrane potential that prevents an ion from flowing down its
concentration gradient, it is also named as Nernst Potential (E ion). When the membrane potential equals
the equilibrium potential for an ion, the net flux of that ion across the membrane is zero. The
equilibrium potential for an ion is the energy (in volts) contained in the concentration gradient.
35
III. Donnan Equilibrium
A Donnan equilibrium is estabilished when a membrane separating two solutions is permeable
to several, but not all, of the ions. The membrane potential (E M) balances the concentration gradient for
each of the ions permeable to the membrane (EM =Eion).
- A cell in Donnan equilibrium is not in osmotic equilibrium. There are more particles inside
the cell because of the presence of intracellular proteins (nondiffusible anions). The osmotic gradient
causes water to flow into the cell.
a) Normal cells are prevented from reaching a Donnan equilibrium by the action of the
Na-K pump, which maintains an intracellular Na + concentration low enough to keep the inside and
outside of the cell in osmotic equilibrium.
b) In brain ischemia, for example, decreased activity of the Na-K pump allows the Na +
concentration to rise. The increase in intracellular osmolarity causes water to flow into the cell,
producing neuronal swelling and damage.
- A Donnan equilibrium exists between the plasma and interstitial fluids because the capillary
membranes are not permeable to the plasma proteins.
a) The plasma has a higher osmolarity than the interstitial fluid
b) The flow of water from the interstitial fluid to the plasma fluid to the plasma fluid is
prevented by the capillary hydrostatic pressure.
III. Steady-State Membrane Potentials
The membrane potential in normal cells is called a steady state potential because the Na +-K+
pump prevents the intracellular and extracellular concentration of Na + and K+ from reaching the
equilibrium.
The steady state potential is called the resting membrane potential.
The magnitude of the resting membrane potential is determined by the concentration gradients
and the conductances (or permeabilities) of the ions that are able to diffuse across the membrane.
Calculating the resting membrane potential: it is calculated using the transference (chord conductance)
or Goldman equation.
The transference equation:
Definition of terms:
Eion = Equilibrium potential. It represents the energy in the concentration
gradient for each of the ions permeable to the membrane.
Tion = transference and represents the relative conductance (g) of each of the ions
permeable to the membrane; for example:
Epump = the membrane potential produced by the Na – K pump. Because this

pump is electrogenic (it pumps three Na ions out of the cell while pumping two K ions into the cell), it
makes the cell slightly negative. However, in most cells except cardiac cells, the magnitude of the
pump potential is so small that it can be ignored.
The magnitude of the resting membrane potential is determined primarily by the concentration
of extracellular K+ because the resting membrane is much more permeable to K+ than it is to Na+.
a) Increases in extracellular K+, which make the equilibrium potential for K + more
positive, cause the membrane potential to depolarize (become more positive).
b) Decreases in extracellular K+, which make the equilibrium potential for K + more
negative, cause the membrane potential to hyperpolarize (become more negative).
36
IV. Nerve Cells’ Action Potentials
The action potential is a transient change in the membrane potential that conveys information
within excitable cells and the nervous system.
Electrically excitable cells (nerve and muscle cells-Beta) generate action potentials when they
are stimulated by a change in membrane potential (by the flow of current into and out the cell).
1) Explique (em português) a diferença entre Potencial de Repouso para Potencial de Ação de
membrana.
Parte 2
Recording action potentials:
- Intracellular recordings of action potentials are made by inserting glass microelectrodes that
have tip diameters of less than 0.5 micrometers through the cell membrane. The small tips prevent
damage to the cell.
The figure below shows the recording made as a microelectrode is inserted into a nerve cell at
rest. The electrical potential is 0mV when the microelectrode is outside the cell and drops to -80mV as
soon as the microelectrode passes through the membrane and enters the intracellular fluid. Note that
this is the resting membrane potential. When the cell is stimulated, the microelectrode records the
changes in membrane potential (action potential).
FIGURE 1 – When a microelectrode is inserted into a nerve cell, a resting membrane potential of -80mV is
recorded. Stimulation produces an action potential, which is also recorded. Note that during upstroke depolarization takes
place as the conductance for Na + increases, and that during downstroke, repolarization occurs as the conductance for K +
increases, allowing K+ to flow out of the cell.
Phases of the Action Potentials:

The phases of action potentials produced by various cell types differ slightly , but in all
action potentials, the change in membrane potential is caused by the flow of current through ion-
specific channels that open or close in response to changes in membrane potential. The phases of the
nerve cell action potential are discussed here.
Threshold – Excitable cells undergo rapid depolarization if the membrane potential is
reduced to a critical level (threshold potential). Once the threshold potential is reached, the remainder
of the depolarization is spontaneous. The action potential is an “all-or-none” response to a stimulus;
that is, if the stimulus is strong enough to reach threshold, the changes in membrane potential that
characterize the action potential are always the same.
37
Upstroke – The rapid depolarization of the membrane after threshold is reached is
the “depolarization phase”, or upstroke, of the action potential. The upstroke is produced by the flow
of Na+ into the cell.
Overshoot – The portion of the action potential during which the membrane is positive
is the overshoot. The peak of the action potential is the overshoot potential.
Downstroke – The rapid return of the membrane toward its resting potential is the
“repolarization phase”, or downstroke, of the action potential. The downstroke is produced by the flow
of K+ out of the cell.
Undershoot – The membrane potential becomes more negative than its resting value at
the end of the action potential. This is the “hyperpolarization phase”, also known as after-
hyperpolarization potential or undershoot, of the action potential.
2a) Cite os principais íons envolvidos nos processos de: Despolarização, Repolarização e
Hiperpolarização de membrana.
2b) Durante a despolarização (upstroke), este íon (citado na 2a) entra ou sai da célula? Cite o(s)
trecho(s), em inglês, do texto que justifica a sua resposta.
Parte 3
- Extracellular recordings usually are made with metal electrodes that are placed on or near the
nerve or muscle.
Because these electrodes are outside the cell, they can record only changes in membrane potential
(action potentials but not resting potentials). They cannot record the exact magnitude or time-course of
the action potentials.
Extracellular recordings are useful in clinical situations when the electrical activity of excitable
tissues must be monitored. For example, electroencephalograms are used to aid in the diagnosis of
brain disease; electrocardiograms are used to detect damage to the heart; and electromyograms, which
are recordings from skeletal muscle, are used to aid in the diagnosis of neuropathies and myopathies.
3a) De acordo com o texto acima, as membranas celulares (das células nervosas, cardíacas e
musculares tipo-Beta) possuem diferença de potencial elétrico entre o meio extra-celular e o intra-
celular. Cite a predominância iônica (positiva ou negativa) do meio extra e do meio intra-
celular com a membrana em “Estado de Repouso” (mantido graças à ação de estruturas e
mecanismos elétro-dinâmicos como a Bomba de Prótons Na-K ATPase).
3b) Explique como se mede o potencial de membrana de um nervo (neurônio periférico)
que gerou o gráfico (rico em detalhes como está no texto acima): Explicando desde a técnica de
inserção de micro-eletrodos com as características iônicas da membrana, incluindo o significado
dos conceitos citados (dos segmentos de traçado gráfico “upstroke” e “downstroke” e os demais e
dos pontos “threshold” e os demais com a caracterização iônica dos potenciais de repouso e ação;
até a finalização do evento – cite os valores envolvidos explicando da maneira que o texto acima
tentou explicar.
3c) Eletroencefalografia, eletrocardiografia e eletromiografia são exames feitos na prática
clínica médica para análise da função dos três tecidos humanos que possuem atividade celular
38
elétrica. Esses exames são, na realidade, registros de atividade elétrica tecidual feitos à distância
(de forma não invasiva): são as aferições extra-celulares. Cite as desvantagens (ou limitações) da
medida de potencial elétrico celular feito no meio extracelular apenas (exame não invasivo)
em relação ao feito intracelular (exame invasivo).
Parte 4
DIABETES
Diabetes mellitus produces multiple systemic effects including the mono- and polyneuropathies
commonly seen in these patients (CHALK & DYCK, 1997). The painful neuropathies with their
burning dysesthetic pain can plague patients for many years (BOULTON & MALIK, 1998). The
tricyclic antidepressants have proven efficacious for this condition in doses considered subtherapeutic
from an antidepressant standpoint (KINGERY, 1997). The sedating adverse effects and the dry mouth
produced by these drugs usually make this class of drug difficult to use except at night. Some patients
may accommodate to these adverse effects, and thus utilize them during waking hours as well.
As with other neuropathic pain stress, the membrane-stabilizing drugs lidocaine and mexiletine
have efficacy and provide an alternative for patients who cannot tolerate tricyclic antidepressants
(DEJGARD et al., 1998). The anti-convulsants carbamazepine (WILTON, 1974) and gabapentin offer
potential relief for this condition. Topically applied capsaicin provides a further alternative for patients
with particularly difficult to manage neuropathy (HAUTKAPPE et al., 1998).
DIABETIC NEUROPATHIES
It is a metabolic neuropathy.
Diabetes is the most frequent cause of peripheral neuropathy worldwide. Incidence figures
depend on the employed definition; at least some peripheral nerve abnormalities can be detected in
about 70% of patients with long-standing diabetes, and symptomatic neuropathy affects 5 to 10%. The
diabetic neuropathies include a variety of clinical forms, including symmetrical polyneropathies, and a
variety of forms of individual nerve injury (Table 462-3).
The Diabetic Polyneuropathy:

Diabetic polyneuropathy is symmetrical and usually distally predominant, beginning with
sensory loss in the feet. It is the most frequent of the diabetic neuropathies. It is uncommon at the time
of diagnosis of diabetes, and its prevalence increases with duration of diabetes. However, an important
subgroup has been identified in which painful sensory neuropathies occur in the stage of early diabetes
or impaired glucose tolerance. The precise pathogenesis of diabetic polyneuropathy remains a matter
of controversy, but a single recent advance has been the demonstration that, like the ocular and renal
complications, diabetic neuropathy can be reduced in incidence and in severity by maintaining blood
sugar levels close to normal. This effect of “tight control” is consistent with the hypothesis that
hyperglycemia itself contributes to nerve damage. The complications of hyperglycemia that injure
nerves may include one or more of the following:
39
I- abnormalities of nerve vasculature and blood flow, leading to angiopathic injury;
II- metabolic effects of abnormalities in polyol pathways;
III- nonenzymatic glycosylation of nerve proteins.
4a) Quais são as 7 neuropatias diabéticas possíveis? Cite-as em português.
verdadeira (V) ou falsa (F) e cite o(s) fragmento(s) do texto (em inglês) que você usou para
4b) Já é fato confirmado que a hiperglicemia, por si só, danifica nervos periféricos.
Clinical Manifestations:
The neuropathy is usually asymptomatic at the onset, a stage during which abnormalities in
sensation and reflexes may be detected on routine examination. The symptomatic phase usually begins
insidiously, but some cases have an abrupt onset; and in a small percentage of patients the onset may
be precipitated by institution of insulin.
Unlike most other neuropathies, in diabetes small-fiber sensibility as well as large-fiber
sensation are typically reduced, resulting in elevated pin, thermal, and vibratory thresholds.
The small-fiber dysfunction is often manifested by spontaneous neuropathic pain, including
bothersome dysesthesias (unpleasant sensations evoked by normally innocuous stimuli, such as the bed
sheets on the toes at night). There may be continuous burning or throbbing pain, and walking often is
distressing (feels like walking on coals). In addition, sudden intense “lightning” pains may affect the
feet and legs.
Some degree of autonomic insufficiency is frequent in diabetic neuropathy. Manifestations
include loss of the normal sinus arrhythmia; failure of blood pressure restoration and cardiac
acceleration on standing, sometimes producing orthostatic hypotension; impotence; constipation; and a
particularly distressing symptom, diabetic diarrhea with unpredictable loose stools and fecal
incontinence. In some patients, these “small-fiber” abnormalities, including neuropathic pain, loss of
pin and thermal sensibility, and autonomic dysfunction, dominate the clinical picture.
The diagnostic of diabetic polyneuropathy is straightforward in established diabetics with
typical clinical pictures. Electrodiagnostic studies, usually unnecessary, document neuropathy, and
CSF protein is frequently moderately elevated. In patients without frank diabetes, a glucose tolerance
test may be required to demonstrate glucose intolerance is prevalent in the adult population, so its
presence does not necessarily mean that it is the cause of neuropathy: other causes must be excluded.
Diabetic neuropathy is the most overdiagnosed cause of peripheral nerve disease. It alone seldom
results in severe painless weakness.
verdadeira (V) ou falsa (F) e cite o(s) fragmento(s) do texto (em inglês) que você usou para
4c) O quadro clínico assintomático da neuroptia diabética impede seu diagnóstico em exames
clínicos de rotina, o que torna a Análise Eletrodiagnóstica imprescindível no acompanhamento de
um paciente diabético.

8º TEMA: Semiologia médica
40
Parte 1
Components of the disease
The diseases are mental categories, each with a particular meaning that gives individuality to be
understood as a nosological entity. Such intellectual distinction (categorization) is based on the
components of each nosological entity which characterize it as such. Consequently, the total
information that makes each nosological entity which is part of the analysis of minimum and partial
units, each representing an aspect of the process of disease. In some cases, certain aspects are unknown
or uncertain, making it difficult a full description of these entities.
Several basic aspects (components) considered for the study of different pathological processes.
Any of these components can be used as taxonomic criteria of different nosologic entities. Here are
some of following aspects.
Concept
The concept of disease is an intellectual approach that provides guidance on the type of disease
in question, and helps your understanding. Every disease has a conceptual component that categorizes
and provides a reference point for identifying what may be common or a distinct nosological entity
from another.
An example: the name 'diabetes', was a significant reference to the passage of water evident in
the increased thirst (polydipsia) and the excretion of urine (polyuria). This led to group two disorders
(diabetes mellitus and diabetes insipidus) that the only thing they have in common is the polydipsia
and polyuria as their causes, frequency, and other events are totally different.
Responda em português: Devido à consagração pelo uso, algumas doenças compartilham nomes
(identificadores), porém são diferentes, Diabetes “mellitus” e Diabetes “insipidus” exemplificam essa situação.
1a) Por que essas duas doenças diferentes compartilham o nome DIABETES?
 ATENÇÃO: para responder adequadamente esta pergunta o aluno deve entender o texto “Components of the disease“ e
explicar-se valendo-se de informações do texto “Concept”.
Epidemiology
Represents significant information was tentatively set on the more likely it is possible to
develop a disease. The science of epidemiology-considered statistically many variables to define such
a case-by-case context (population, environmental, ethnic, genetic, labor, environmental, etc.).
The epidemiology of a disease also provides parameters to determine the importance of
pathology in particular in relation to his case (frequency of cases) and the probability of identifying a
cause for such cases.
Etiology
For a disease, the etiology is the main cause identified; represents the starting point for
developing the disease. Factor is the sine qua non for the genesis of the disease process. However, in
many disease processes and substitutes, the etiology is uncertain or unknown. In this aspect, it is a
primary distinction, which makes syndromes plurietiologic entities, while at most diseases have a
single cause.
In this context, it should be noted that along with the etiology are often described triggers of the
disease. Often, there are certain circumstances that are not due (at least directly) from the disease, as
facts are kicking themselves in the process.
Sometimes, for an illness, described his "pathogenesis": its etiology and pathogenesis of a
conjugate as a unified process.
Pathogenesis
41
Pathogenesis, patogenesia or is the description (sometimes tentative) complex
pathophysiological process that develops from the effects triggered by the etiological factor. This
description defines the transition to the status of disease.
The pathogenesis of the disease is a representation of the altered mechanisms of normal
physiology that generate, sustain and end or perpetuate the disease process by promoting a cause
(etiology).
1b) Diferencie, aproveitando os conceitos apresentados neste texto acima, mas em português:
PATOGÊNESE de ETIOLOGIA de uma doença.
ABOUT APPENDICITIS
“The exact pathophysiology of acute appendicitis is not entirely clear, but the prevailing theory
is that appendiceal luminal obstruction is the key mechanism. In the adult population, fecaliths, as well
as rare scarring or tumor, are the main causes of obstruction leading to acute appendicitis.
Obstruction causes distention of the lumen of the appendix, yielding increased intramural and
intraluminal pressures. This leads to lymphatic and vascular compromise with ischemia and then
necrosis of the appendix with associated bacterial overgrowth. In the first 24 hours, the great majority
of patients have inflammation and possibly necrosis, with perforation uncommon. Common organisms
associated with late appendicitis are Escherichia coli, Streptococcus species, Proteus, Bacteroides
fragilis, and Pseudomonas species.”
1c) Ciente da diferença entre ETIOLOGIA e PATOGÊNESE, responda: “As bacterias (E. coli, S.
species, B. fragilis, P. species) são elementos (1) etiológicos ou (2) patogênicos na apendicite?”
Justifique sua resposta (uma a três linhas).
Pathological findings
The anatomical and histological study allows to investigate for evidence of physical-chemical
process of disease, which is reflected in alterations of normal morphology and physiology at any level
(molecular, cellular, tissue, organic, etc.). The discovery of this evidence, generally, is a definitive
diagnosis.
There are several techniques and methodologies to demonstrate the various morphofunctional
injuries, and determine its interpretation in the context of the pathogenesis, since the lesions can be
seen as milestones that mark a year: pathogenesic the path that leads toward a kind of disease.
Clinical Picture
“Clinical” is a meaningful context or framework, defined by the relationship between the signs
and symptoms that occur in a given disease (in fact, introducing the ill). Clinical semiology is the tool
that allows clinical definitions, which can be distinguished:
Symptoms are the subjective reference on which the patient's own perception of the
manifestations of the illness suffered. Symptoms are the patient's statement about what happens.
Symptoms by their subjective nature, are highly variable, sometimes unreliable and not very accurate,
and sometimes, their interpretation can be difficult. Still, its value in the diagnosis is clear.
Clinical signs: The signs from the examination or psychological exploration of the patient.
Clinical signs include sensory elements (related to the senses), collected in the biology of the patient
from observation, smelling, palpation, percussion and auscultation, in addition to the application of
certain maneuvers. Every sign is in full meaning as it has an interpretation as a semiological.
ABOUT APPENDICITIS
“Initial features in the history are typically nonspecific, including indigestion, change in bowel
habits, and malaise. Following this, patients most typically experience visceral-type pain in the
42
periumbilical or sometimes epigastric region that is characteristically intermittent, poorly localized,
and often not terribly severe. Nausea and vomiting, which can occur, usually follow the onset of pain.
Similarly, fever may be present and usually occurs following the onset of pain. The presence of
high fever (>39.4°C) may be a sign of a perforated appendix. Early stages of appendicitis may not
elicit tenderness on physical examination. Signs of localized inflammation or peritonitis occur as the
disease progresses. Patients with an appendix in the anterior position typically have tenderness in the
right lower quadrant near McBurney's point (two thirds of the distance from the umbilicus to the
anterior superior iliac crest), often associated with peritoneal signs. In contrast, patients with a
retrocecal appendix often have less impressive tenderness. Tenderness in patients with a pelvic
appendix is often below McBurney's point. These patients often have symptoms of dysuria, urinary
frequency, diarrhea, or tenesmus. Several classical maneuvers on physical examination to aid in the
diagnosis of appendicitis have been described: I- Rovsing’s sign (palpation of the left lower quadrant
eliciting pain in the right lower quadrant), II- Obturator sign (Pain with internal rotation of the hip in
cases of pelvic localization of the appendix), III- Iliopsoas sign (Extension of the right hip eliciting
pain in the right hip for the retrocecal appendix).
Talvez a grande diferença entre Sintomas e Sinais Clínicos seja o fato de que a anamnese é suficiente
para se conhecer os sintomas do paciente, mas só o exame físico detecta e confirma os Sinais Clínicos
(ou manifestações reativas) da “doença”.
1d) Enumere (cite) os Sintomas e os Sinais Clínicos da Apendicite Aguda (em português).
Investigations
The evidence of clinical semiology involve providing additional information from the biology
of the patient by applying different techniques, usually instrumental. The results produced by the tests
should be interpreted as complementary.
Examples of evidence are all the imaging techniques (ultrasound, X-ray, CT, MRI,
scintigraphic, etc..) Electocardiograma, spirometry, blood tests (blood count), myelogram, punctures
(several), urinalysis, psychological tests, physical tests, polysomnography, and so on.
Diagnosis
It is a complex process that develops the professional, and implies a cognitive response to the
raising of the status of the patient. The diagnosis can determine whether or not a pathological condition
(also diagnosed in a patient's health).
The process includes the differential diagnosis, ie the valuation of all possible causes nosologic
that might give a similar clinical picture. It remains to choose the most appropriate depending on the
results of a case history, physical examination, complementary tests, and sometimes treatment.
Evolution
Evolution or natural history of the disease represents a sequence or course of events between
the biological action sequence components of the causes (etiology) to which the disease occurs and the
outcome (cure, step by chronicity or death). The natural history of the disease represents an evolution
of the disease process without medical intervention.
Treatment
Consists of all those options environmental, human, physical, chemical, among others, that
contribute to the healing of the patient, the process, or to alleviate their symptoms (palliative
treatment) if possible to improve their quality of life achieved incorporation into society.
Forecast
Represents information of a statistical trend that continues on a disease process. Many variables
must be taken into account when preparing a forecast (age, gender, race, moment of onset, etiologic
factors, associated diseases, therapy acceptance and efficiency / effectiveness). It is not always
possible to predict the evolution of disease, with or without treatment.
1e) Dê a sua versão ao português (versão) para “FORECAST”.
43
1f) Diferencie Evolution de Forecast (em suas palavras, em português).
 Para isso, mencione os itens necessários para elaborar adequadamente o Forecast de um paciente.
Prevention
Prevention or prophylaxis is information pertaining to actions that alter the probability of
disease, reducing the risks. Prevention involves action measures aimed at preventing disease and
improving health status.
Entende-se, do parágrafo acima, que Prevenção (ou profilaxia) fundamenta-se em ações não apenas
para prevenir doenças.
1g) Qual a outra meta da Profilaxia (cite em português)?
Parte 2
Diarrhea Questions Medical History Taking
Diarrhoea is subjective, and can be defined as an increase in the volume, frequency or fluidity
of stool relative to normal for the patient. Dysentery is diarrhoea with the presence of blood, mucous
and protein in the stool, and often associated with signs and symptoms of systemic illness, e.g. fever,
weight loss, anorexia, abdominal pain and dehydration.
Acute diarrhoea can be categorised into (a) osmotic; (b) secretory; (c) inflammatory and (d)
dysmotility. With osmotic diarrhoea, fasting usually results in resolution of the diarrhoea, but with
secretory diarrhoea fasting probably will make no difference.
Causes of osmotic diarrhoea: laxatives, antacids, other drugs, congenital malabsorption
Causes of secretory diarrhoea: bacteria, viruses, certain drugs. Faecal red blood cells (RBCs)
and white blood cells (WBCs) uncommon; systemic symptoms uncommon
Causes of inflammatory diarrhoea: invasive bacteria and parasites, inflammatory bowel disease,
chemotherapy and radiotherapy. Faecal Red Blood Cells and White Blood Cells common; systemic
symptoms common.
2a) Diferencie em suas palavras (mas de acordo com o texto acima) Diarréia de Desinteria.
Analise a afirmações abaixo e compare com as informações contidas no texto acima. Julgue
verdadeira (V) ou falsa (F) e cite o fragmento do texto (em inglês) que você usou para
2b) A alimentação agrava a diarréia do tipo osmótica.
1) Questions to ask:
a) Volume, frequency and character of stools?
b) Blood/mucous in stool?
c) Onset and duration? Onset in relation to pain (which came first)? If diarrhoea first then pain,
gastroenteritis likely
d) Does anything, e.g. eating/drinking, exacerbate/relieve diarrhoea?
e) Has the patient tried any medication for the diarrhoea? Has it worked?
f) Associated features? Nausea, vomiting, fever, abdominal pain, constipation
g) Is diarrhoea the biggest problem, or are there other more pressing concerns?
h) HIV, transplants, malignancy, chemo/radiotherapy, abdominal surgery?
i) Past history/family history of diarrhoeal diseases?
j) Anyone else around you have diarrhoea? Are you associated with day care centres?
k) Recent dietary history: recent consumption of meats (cooked, uncooked), eggs, seafood, dairy foods
and unusual foods
44
l) Recent travel to developing countries? Recent outdoor activities such as bushwalking? If so, what
was the food + water situation?
2c) Dê sua versão (em português médico acadêmico) para STOOL e para TO STOOL.
Parte 3
HYPOCALCEMIA HYPERCALCEMIA
symptoms and signs symptoms and signs
Hypocalcemia increases excitation of nerve Hypercalcemia may affect
and muscle cells, primarily affecting the gastrointestinal, renal and neurologic
neuromuscular and cardiovascular systems. function.
Extensive spasm of skeletal muscles causes The focus of the history and physical
cramps and tetany. Laryongospasm with stridor can examination should be on the duration of
obstruct the airway. Convulsions can occur as well the process of hypercalcemia and evidence
as paresthesias of lips and extremities and of neoplasm. Symptoms irrespective of
abdominal pain. Chvostek’s sign (contraction of cause are constipation and polyuria. Other
ADULTS
facial muscle in response to tapping the facial nerve gastrointestinal symptoms may include
anterior to the ear) and Trousseau’s sign (carpal nausea, vomiting, anorexia and peptic ulcer
spasm occurring after occlusion of the brachial disease. Renal colic or hematuria from
artery with a blood pressure cuff for 3 minutes) are nephrolithiasis may be present. Polyuria
usually readily elicted. from hypercalciuria-induced nephrogenic
diabetes insipidus can result in volume
depletion and azotemia (hyperurecemia).
Neurologic manifestations may
range from mild drowsiness to weakness,
depression, lethargy, stupor and coma in
severe hypercalcemia.
Prolonged hypocalcemia causes tetany, Findings include hypotonicity and
photophobia, blepharospasm and diarrhea. The weakness of muscles; apathy, mood swings
symptoms of tetany include numbness, cramps and and bizarre behavior; nausea, vomiting,
twitchings of the extremities; carpopedal spasm and abdominal pain, constipation and weight
laryngospasm; a positive Chvostek sign; loss; hyperextensibility of joints;
INFANTS
unexplained bizarre behavior, irritability, loss of hypertension, cardiac irregularities,

consiousness, convulsions and retarded physical bradycardia. Coma occurs rarely. Calcium
and mental development. Headache, vomiting, deposits in the cornea or conjunctiva may
increased intracranial pressure and papilledema occur and are detected by slit-lamp
may occur. In early infancy, respiratory distress examination of the eye. Intractable peptic
may be the presenting finding. ulcer and pancreatitis occur in adults but
rarely in children.
3a) O Sinal de Chvostek é negativo ou é positivo na Hipercalcemia? (DESnecessário justificar).

3b) Descreva em suas palavras um Sinal de Chvostek positivo.
45
9º TEMA: Cirurgia
Parte 1
Fonte: emedicinehealth.com (Jerry R. Balentine, DO, FACEP - Medical Author; Melissa Conrad Stöppler, MD - Chief Medical Editor)
ABDOMINAL PAIN IN ADULTS
OVERVIEW
Abdominal pain can range in intensity from a mild stomach ache to severe acute pain. The pain
is often nonspecific and can be caused by a variety of conditions. Many organs are found within the
abdominal cavity. Sometimes the pain is directly related to a specific organ such as the bladder or
ovary, while other times it is more diffuse or non-specific. Usually, abdominal pain originates in the
digestive system. For example, the pain can be caused by appendicitis, diarrheal cramping, or food
poisoning.
How is the Cause of Abdominal Pain Diagnosed?
Doctors determine the cause of abdominal pain by relying on: 1.Characteristics of the pain;
2.Physical examination; 3.Exams and tests; 4.Surgery and endoscopy.
The type and location of pain may help the physician find the cause. The intensity and duration
of pain must also be considered when making a diagnosis. A few general characteristics of abdominal
pain are as follows:
Character of Pain: Abdominal pain can be sharp, dull, stabbing, cramp-like, knifelike, twisting,
or piercing. Many other types of pain are possible.
Duration of Pain: Abdominal pain can be brief, lasting for a few minutes, or it may persist for
several hours and longer. Sometimes abdominal pain comes on strongly for a while and then lessens in
intensity for a while.
Triggering Events: The pain may be worsened or relieved by certain events, such as worse after
meals, better with a bowel movement, better after vomiting, or worse when lying down.
Abdominal pain can make a person want to stay in one place and not move a muscle. Or the
pain can make them so restless they want to pace around trying to find "just the right position."
The health care professional will try to pinpoint the area of the abdomen where the pain
originates when determining the cause of abdominal pain. This is done by combining questions such as
- "When you first had the pain, where did you feel it?" - with examination of the abdomen. Softly
pressing on certain areas to elicit the pain and perhaps palpating other areas to examine the size and
exact location of an organ are other parts of the physical examination.
When this is combined with general questions about the pain such as "Is the pain dull or
sharp?" "How long have you had the pain?" and questions about your state of health - "Did you have to
vomit?" - the health care professional can narrow down the possible causes of the pain.
Once the questions and physical exam are completed, the health care professional will either
give the patient a diagnosis and advise on follow-up recommendations or order blood tests, and
possibly X-rays and imaging studies to further help identify why the patient is in pain.
1a) Dê a sua melhor versão ao português para as seguintes expressões referentes a dor
abdominal: 1) Acute abdomen; 2) Stomach ache; 3) Belly pain; Tummy ache; 4) Diarrheal
cramping.
1b) O texto acima cita 7 características para especificar o tipo de dor abdominal. Dê uma
tradução em linguagem médica e uma em linguagem popular-regional.
46
1c) O que são “triggering eventes”? Explique em português, duas a seis linhas, nas suas palavras.
.
Parte 2
ANAMNESIS
Diagnosing the cause of abdominal pain is one of the hardest tasks for a health care
professional. Sometimes all that the professional can do is be sure that the pain does not require
surgery or admission to the hospital.
Characterizing the pain with a few group of questions: 1. The Way the Pain Begins; 2. The
Pain’s Location; 3. The Pain’s Pattern; 4. The Pain’s Duration; 5. What Makes the Pain Worse? 6.
What Relieves the Pain? 7. Pain’s Associated Signs and Symptoms.
The health care professional may ask these or similar questions to try to determine what is
causing the patient's pain. Some may seem unrelated to the patient's current condition, but try to
answer them as completely as possible. The answers to these questions can help the health care
professional find the cause of the patient's pain more quickly and easily:
1. How long have you had the pain?
2. What were you doing when it started?
3. How did you feel before the pain started?
4. Have you felt OK over the last few days?
5. What have you tried to make the pain better? Did it work?
6. What makes the pain worse?
7. Does the pain make you want to stay in one place or move around?
8. How was the ride to the hospital? Did riding in the car hurt you?
9. Is the pain worse when you cough?
10. Have you thrown up?
11. Did throwing up make the pain better or worse?
12. Have your bowel movements been normal?
13. Are you passing gas?
14. Do you feel you might have a fever?
15. Have you had a pain like this before? When? What did you do for it?
16. Have you ever had surgery? What surgery? When?
17. Are you pregnant? Are you sexually active? Are you using birth control?
18. Have you been around anyone with symptoms like this?
19. Have you traveled out of the country recently?
20. When did you eat last? What did you eat?
21. Did you eat anything out of the ordinary?
22. Did your pain start all over your stomach and move to one place?
23. Does the pain go into your chest? Into your back? Where does it go?
24. Can you cover the pain with the palm of your hand, or is the hurting area bigger than that?
47
25. Does it hurt for you to breathe?
26. Do you have any medical problems such as heart disease, diabetes, or AIDS?
27. Do you take steroids? Pain medicine such as aspirin or Motrin?
28. Do you take antibiotics? Over-the-counter pills, herbs, or supplements?
29. Do you drink alcohol? Coffee? Tea?
30. Do you smoke cigarettes?
31. Do you use cocaine or other drugs?
2) Corresponda logicamente cada frase-resposta em português abaixo (A-E) com sua pergunta
equivalente em inglês acima (NUMERADAS de 1 a 31):
(A) O paciente refere interrupção da flatulência. ( )
(B) O paciente refere episódios de vômito alimentar. ( )
(C) O paciente chegou há uma semana de área endêmica estrangeira de cólera. ( )
(D) A paciente desconhece-nega gestação em curso. ( )
(E) O paciente refere a dor em todo andar inferior do abdome. ( )
Parte 3
PHYSICAL EXAMINATION
Physical examination will include a careful examination of the patient's abdomen, heart, and
lungs in order to pinpoint the source of the pain.
Examining the patient will provide the doctor with additional clues to the cause of abdominal
pain. The doctor will determine: the presence of sounds coming from the intestines that occur
when there is obstruction of the intestines;
the presence of signs of inflammation (by special maneuvers during the examination);
the location of any tenderness;
the presence of a mass within the abdomen that suggests a tumor, enlarged organ, or
abscess (a collection of infected pus);
the presence of blood in the stool may signify an intestinal problem such as an ulcer,
colon cancer, colitis, or ischemia.
The examiner will touch different parts of the abdomen to check for tenderness or other signs
that indicate the source of the pain.
The examiner may do a rectal exam to check for small amounts of blood in the stool or other
problems such as a mass or internal hemorrhoids.
If the patient is a man, the doctor may check the penis and testicles.
If the patient is a woman, the doctor may do a pelvic exam to check for problems in the uterus,
Fallopian tubes, and ovaries.
48
The doctor also may look at the patient's eyes for yellow discoloration (jaundice) and in the
mouth to be sure the patient is not dehydrated.
3) Analise as afirmações abaixo e compare com as informações contidas no texto acima.
Julgue verdadeiras (V) ou falsas (F) e cite o fragmento do texto (em inglês) que você usou
3a) Tórax, precórdio e escleras são áreas incluídas no exame físico investigativo da dor
abdominal.
3b) O texto refere a necessidade e cita todas as manobras específicas para “checagem” de sinais
da presença e localização de inflamações.
3c) JAUNDICE é o termo usado em inglês para descrever mucosas oculares secas ou sem brilho
(desidratação).
Parte 4
LABORATORY TESTS
Laboratory tests may not help to find the cause of the abdominal pain. However, if combined
with the information gained from the questions the patient was asked and the physical examination
performed by the health care professional, certain blood or urine tests may be ordered and could assist
in determining the diagnosis.
Laboratory tests such as the complete blood count (CBC), liver enzymes, pancreatic enzymes
(amylase and lipase), and urinalysis are frequently performed in the evaluation of abdominal pain.
One of the most important tests is to see if a woman is pregnant.
A raised white blood cell count may mean infection or may just be a reaction to the stress of
pain and vomiting.
A low blood count (hemoglobin) may show that the patient is bleeding internally, but most
conditions that involve bleeding are not painful.
Blood in the urine, which may not be visible to the eye, may suggest the patient may have a
kidney stone.
Other blood tests, such as liver enzymes and pancreas enzymes, can help determine which
organ is involved, but they do not point to a diagnosis.
Some possible laboratory tests conclusions are:
An elevated white count suggests inflammation or infection (as with appendicitis,
pancreatitis, diverticulitis or colitis.
Amylase and lipase (enzymes produced by the pancreas) commonly are elevated in
pacreatitis.
Liver enzymes may be elevated with gallstones attacks.
Blood in the urine suggest kidney stones.
When there is diarrhea, white blood cells in the stool suggest intestinal inflammation.
4) Qual a finalidade da dosagem sérica da Amilase e da Lipase na investigação da dor
abdominal (segundo este texto acima)?
Parte 5
RADIOLOGY TESTS
49
Radiology studies of the patient's abdomen can be useful, but are not always necessary or
helpful. Their usefulness are listed in the figure below the text.
Occasionally, an X-ray will show air outside of the bowel, meaning that something has
ruptured or perforated. An X-ray also can help diagnose bowel obstruction. Sometimes X-rays can
show a kidney stone.
Plain X-rays of the abdomen also are referred to as a KUB (because they include the kidney,
ureter, and bladder). The KUB may show enlarged loops of intestines filled with copious amounts of
fluid and air when there is intestinal obstruction. Patients with a perforated ulcer may have air escape
from the stomach into the abdominal cavity. The escaped air often can be seen on a KUB on the
underside of the diaphragm. Sometimes a KUB may reveal a calcified kidney stone that has passed
into the ureter and resulted in referred abdominal pain or calcifications in the pancreas that suggests
chronic pancreatitis.
Ultrasound is a painless procedure useful in finding some causes of abdominal pain.
This may be done if the health care professional suspects problems with the gallbladder,
pancreas, liver, or the reproductive organs of women. Ultrasound also assists in the diagnosis of
problems with the kidneys and the spleen, or the large blood vessels that come from the heart and
supplies blood to the lower half of the body.
CT scan is a special type of x-ray that provides useful information about the liver, pancreas,
kidneys and ureters, spleen, and small and large intestine, including diseases such as appendicitis and
diverticulitis.
Patient and the health care professional should discuss the diagnostic needs for an X-ray, and
the potential radiation exposure before proceeding with any X-ray examination.
The health care professional may perform no tests at all. The cause of the patient's pain may be
clear without any tests and may be known not to be serious. If the patient does undergo tests, the
professional should explain the results to them (Figure).
5) Dê uma versão de uso médico no Brasil para KUB-Ultrassound.
Parte 6
ENDOSCOPIC PROCEDURES
Endoscopy is the examination of the inside of the body (commonly the esophagus, stomach,
and portions of the intestine) by using a lighted, flexible instrument called an endoscope. Examples of
abdominal:
Esophagogastroduodenoscopy or EGD is useful for detecting ulcers, gastritis or
stomach cancers.
50
Colonoscopy or Flexible Sigmoidoscopy is useful for diagnosing infectious colitis,
ulcerative colitis, or colon cancer.
Endoscopic Ultrasond or EUS is useful for diagnosing pancreatic tumors or gallstones if
the standard ultrasound or CT or MRI scans fail to detect them.
Ballon Endoscopy, the newest technique allows endoscopes to be passed through the
mouth or anus and into the small intestine where small intestine causes of abdominal pain or bleeding
can be diagnosed, biopsied, or treated.
Fontes: 1) ASGE (American Society for Gastrointestinal Endoscopy) TECHNOLOGY COMMITTEE, et al. Enteroscopes. Gastrointest Endosc. 2007;66(5):872-80. 2)
Yamamoto H, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001;53(2):216-20.
BACKGROUND – DEFINITIONS
ENTEROSCOPY describes endoscopic examination of the small intestine, extending
into the jejunum and/or the ileum. EGD is normally used to describe procedures into the duodenum.
Limited terminal ileal examinations are usually included under the term colonoscopy.
“PUSH ENTEROSCOPY” (PE) is performed with a specifically designed enteroscope,
with or without an overtube, or a colonoscope without an overtube.
DOUBLE-BALLOON ENDOSCOPY (DBE) involves a specially coupled enteroscope
and overtube apparatus with balloons mounted on the distal ends of each component and is intended
for examination of the entire jejunum and the ileum.
SINGLE-BALLOON ENDOSCOPY (SBE) uses a similar concept with an enteroscope
and an overtube that contains a balloon on its distal end. Intraoperative enteroscopy (IOE) is a
procedure in which an endoscope is inserted orally or via an enterotomy and is manually guided
through the small bowel with surgical assistance.
WIRELESS CAPSULE ENDOSCOPY (WCE) is a purely diagnostic technology that is
used to identify and roughly localize lesions.
SONDE ENTEROSCOPY is also purely diagnostic, and uses a very long small-caliber
endoscope that is passed deep into the small bowel by peristalsis over the course of several hours and
is then retracted for viewing. Sonde enteroscopy is an obsolete technique.
“PUSH ENTEROSCOPES” are longer versions of standard videoendoscopes and are
compatible with standard processing units. They have a working length of 2200 to 2500 mm, external
diameters of 10.5 to 11.7 mm, and channel diameters of 2.2 to 3.8 mm. However, the length of the
instrument does not necessarily correlate with deeper insertion or improved diagnostic yield. Prototype
variable-stiffness enteroscopes appear to enhance procedural performance and depth of insertion.
OVERTUBES have been used to facilitate deeper jejunal intubation during PE. They
have an outer diameter of 14.4 mm, a flexible segment at the distal end, and a radiopaque ring at the
tip. However, results are mixed, and overtubes are not regularly used because of complications.
An overtube is a sleeve-like device designed to facilitate endoscopy. All overtubes have an
inner diameter larger than an endoscope, providing a conduit for passage of the device into the
digestive tract. Overtubes are intended to protect the GI mucosa from trauma and limit the risk of
aspiration. They also facilitate access in patients with challenging anatomy, increase the depth of
insertion, and maintain access for repeated withdrawal and reinsertion. This overview covers the
design and use of overtubes marketed for various general applications as well as overtubes designed
for specific functions including those marketed with enteroscopes.
DBE requires an endoscopist and an assistant to operate the system and to manipulate the
endoscope and the overtube.
51
Mucosal examination and therapy are performed during both insertion and retraction.
When the apparatus is assembled, the balloons are deflated to begin the procedure.
For the oral approach, the patient is fasted, but no other preparation is required. The endoscope
and the overtube are inserted into the duodenum, and the balloon on the overtube is inflated to
maintain a stable position. With its balloon deflated, the endoscope is inserted up to 40 cm beyond the
overtube, the endoscope balloon is reinflated, the overtube balloon is deflated, and the overtube is
advanced to the tip of the endoscope. The overtube balloon is then reinflated, so that the entire
apparatus is secured in the intestine with both balloons inflated. The entire endoscope-overtube
apparatus is then retracted, which pleats the intestine along the overtube like a compressed concertina.
This procedure is repeated, and the device is advanced through the intestine in increments of up
to 40 cm. When the desired insertion distance is achieved, the intestine is marked with a tattoo if there
is suspicion of more distal lesions. Withdrawal is initiated with the endoscope balloon inflated, and the
overtube balloon is deflated. The overtube is retracted and then the overtube balloon is reinflated.
Endoscope retraction is always performed with the overtube secured by its balloon to prevent
uncontrolled loss of depth.
A circumferential white mark on the endoscope insertion tube 140 cm proximal to the balloon
represents a stopping point beyond which the overtube should not be advanced or the endoscope
withdrawn. This prevents the overtube from shearing off the endoscope balloon, as shown in Figure
Above. DBE is usually performed with fluoroscopic guidance.
A, Video endoscope (SIF-Q240, Olympus) with balloon attached at tip and handmade overtube with another balloon
attached in place on the insertion tube. B, Cylindrical balloon attached at tip of enteroscope. C, Distal end of
overtube with attached balloon. D. Endoscopic view of the Meckel's diverticulum.
6a) Cite 3 a 6 utilidades para o OVERTUBE (tubo guia externo).

Analise as afirmações abaixo e compare com as informações contidas no texto acima. Julgue
6b) Enteroscopia é o termo para investigação endoscópica de todo o intestino: incluindo (ou não)
o duodeno até o reto.
6c) São os aparelhos endoscópicos balonados (especificamente) que permitem sua introdução
pela boca ou ânus e sua introdução no intestino delgado.
Parte 7
SURGICAL INVESTIGATION
Sometimes, diagnosis requires examination of the abdominal cavity either by surgeries:
Laparoscopy and-or Exploratory Laparotomy.
Laparoscopy is a type of surgery in which small incisions are made in the abdominal wall
through which a laparoscope and other instruments can be placed to permit structures within the
abdomen and pelvis to be seen. In this way, a number of surgical procedures can be performed without
the need for a large surgical incision.
52
7) Defina LAPAROSCOPIA em suas palavras usando a sua tradução do texto acima (duas a
oito linhas)
Parte 8
WHY CAN DIAGNOSIS OF THE CAUSE OF ABDOMINAL PAIN BE DIFFICULT?
Modern advances in technology have greatly improved the accuracy, speed, and ease of
establishing the cause of abdominal pain, but significant challenges remain. There are many reasons
why diagnosing the cause of abdominal pain can be difficult.
Symptoms May Be Atypical:

For example, the pain of appendicitis sometimes is located in the right upper abdomen, and the
pain of diverticulitis is on the right side. Elderly patients and patients taking corticosteroids may have
little or no pain and tenderness when there is inflammation, for example, with cholecystitis or
diverticulitis. This occurs because the elderly show fewer symptoms and signs of inflammation and
corticosteroids reduce the inflammation.
Tests Are Not Always Abnormal:
Ultrasound examinations can miss gallstones, particularly small ones.
CT scans may fail to show pancreatic cancer, particularly small ones.
The KUB can miss the signs of intestinal obstruction or stomach perforation.
Ultrasounds and CT scans may fail to demonstrate appendicitis or even abscesses, particularly
if the abscesses are small.
The CBC and other blood tests may be normal despite severe infection or inflammation,
particularly in patients receiving corticosteroids.
Diseases Can Mimic One Another:
IBS symptoms can mimic bowel obstruction, cancer, ulcer, gallbladder attacks, or even
appendicitis.
Crohn's disease can mimic appendicitis.
Infection of the right kidney can mimic acute cholecystitis.
A ruptured right ovarian cyst can mimic appendicitis; while a ruptured left ovarian cyst can
mimic diverticulitis.
Kidney stones can mimic appendicitis or diverticulitis.
The Characteristics of the Pain May Change:
Examples discussed previously include the extension of the inflammation of pancreatitis to
involve the entire abdomen and the progression of biliary colic to cholecystitis.
8) Enumere os fatores que podem tornar a investigação da dor abominal inconclusiva.
53

10º TEMA: artigos científicos
Os artigos científicos estão em anexo e as questões/tarefas de sala serão apresentadas durante a

explanação do professor em sala (Aula Teórica):
54

Ingles Med Apostila 2024

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Inglês Médico

Dia/ ATIVIDA TEMA NATUREZA

Fonte: https://www.med.wisc.edu (em 2012)

Trabalha-se um parágrafo por vez (em sala):

Tarefa 3 / Responda objetivamente, extraindo “em inglês” a resposta do texto acima. E dê

Tarefa 4 / Responda objetivamente em português (a partir do texto acima):

2º TEMA: anatomia médica

Camper and Scarpa fasciae

Muscles of the Abdominal Wall

Muscles of the abdominal wall & the arcuate line.

Transversus abdominis muscle

Rectus abdominis muscles

ABOUT THE RIGHT INFERIOR ABDOMINAL QUADRANT – VERMIFORM APPENDIX

APENDICITE: ETIOLOGIA E PATOGÊNESE

APENDICECTOMIA – PONTOS TÉCNICOS

Autores de livros, não têm a pretensão de ensinar ao leitor a operar (exemplo:

4º TEMA: biologia molecular

The membrane is given rigidity by interspersion of cholesterol molecules, a molecule we have

O fundamento físico para a geração de imagem na escala nanométrica.

 Liposomes  Microchip systems

About Drug Delivery Systems and new/revolutionaries administration ways

3) Crie (livremente) uma hipótese inédita para dispositivo de micro-perfuração tissular

 About FDA Organization:

Cosmético Drug Delivery

Epump = the membrane potential produced by the Na – K pump. Because this

Phases of the Action Potentials:

The Diabetic Polyneuropathy:

unexplained bizarre behavior, irritability, loss of hypertension, cardiac irregularities,

3a) O Sinal de Chvostek é negativo ou é positivo na Hipercalcemia? (DESnecessário justificar).

5) Dê uma versão de uso médico no Brasil para KUB-Ultrassound.

6a) Cite 3 a 6 utilidades para o OVERTUBE (tubo guia externo).

Symptoms May Be Atypical:

Os artigos científicos estão em anexo e as questões/tarefas de sala serão apresentadas durante a

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